Dataset Information

Long-Term Antithrombotic Treatments Prescribed for Cardiovascular Diseases in Patients with Hemophilia: Results from the French Registry.

ABSTRACT: Cardiovascular diseases (CVDs) are a major issue in aging patients with hemophilia (PWHs). Antithrombotic agents are widely used in the general population for CVD treatment, but this recommendation is not fully applicable to PWHs. To improve treatment strategies, a prospective case-control study (COCHE) that analyzed CVD management and follow-up (2 years/patient) in PWHs was performed in France from 2011 to 2018. In total, 68 PWHs (median age: 65 years [39-89]; 48 mild, 10 moderate, and 10 severe hemophilia) were included (n?=?50 with acute coronary syndrome, n?=?17 with atrial fibrillation, n?=?1 with both). They were matched with 68 control PWHs without antithrombotic treatment. In our series, bleeding was significantly influenced by (1) hemophilia severity, with a mean annualized bleeding ratio significantly higher in COCHE patients than in controls with basal clotting factor level up to 20%, (2) antihemorrhagic regimen (on-demand vs. prophylaxis) in severe (hazard ratio [HR]?=?16.69 [95% confidence interval, CI: 8.2-47.26]; p?<?0.0001) and moderate hemophilia (HR?=?42.43 [95% CI: 1.86-966.1]; p?=?0.0028), (3) type of antithrombotic treatment in mild hemophilia, with a significantly higher risk of bleeding in COCHE patients than in controls for dual-pathway therapy (HR?=?15.64 [95% CI: 1.57-115.8]; p?=?0.019), anticoagulant drugs alone (HR?=?9.91 [95% CI: 1.34-73.47]; p?=?0.0248), dual antiplatelet therapy (HR?=?5.31 [95% CI: 1.23-22.92]; p?=?0.0252), and single antiplatelet therapy (HR?=?3.76 [95% CI: 1.13-12.55]; p?=?0.0313); and (4) HAS-BLED score ?3 (odds ratio [OR]?=?33 [95% CI: 1.43-761.2]; p?=?0.0065). Gastrointestinal bleeding was also significantly higher in COCHE patients than in controls (OR?=?15 [95% CI: 1.84-268]; p?=?0.0141). The COCHE study confirmed that antithrombotic treatments in PWHs are associated with increased bleeding rates in function of hemophilia-specific factors and also of known factors in the general population.

SUBMITTER: Guillet B

PROVIDER: S-EPMC7895544 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Long-Term Antithrombotic Treatments Prescribed for Cardiovascular Diseases in Patients with Hemophilia: Results from the French Registry.

Guillet Benoît B Cayla Guillaume G Lebreton Aurélien A Trillot Nathalie N Wibaut Bénédicte B Falaise Céline C Castet Sabine S Gautier Philippe P Claeyssens Ségolène S Schved Jean-François JF

Thrombosis and haemostasis 20201024 3

Cardiovascular diseases (CVDs) are a major issue in aging patients with hemophilia (PWHs). Antithrombotic agents are widely used in the general population for CVD treatment, but this recommendation is not fully applicable to PWHs. To improve treatment strategies, a prospective case-control study (COCHE) that analyzed CVD management and follow-up (2 years/patient) in PWHs was performed in France from 2011 to 2018. In total, 68 PWHs (median age: 65 years [39-89]; 48 mild, 10 moderate, and 10 sever ...[more]

PMID: 33099283

Similar Datasets

Project description:BACKGROUND:Hyperoxemia has been associated with increased mortality in critically ill patients, but little is known about its effect in trauma patients. The objective of this study was to assess the association between early hyperoxemia and in-hospital mortality after severe trauma. We hypothesized that a PaO2???150?mmHg on admission was associated with increased in-hospital mortality. METHODS:Using data issued from a multicenter prospective trauma registry in France, we included trauma patients managed by the emergency medical services between May 2016 and March 2019 and admitted to a level I trauma center. Early hyperoxemia was defined as an arterial oxygen tension (PaO2) above 150?mmHg measured on hospital admission. In-hospital mortality was compared between normoxemic (150?>?PaO2???60?mmHg) and hyperoxemic patients using a propensity-score model with predetermined variables (gender, age, prehospital heart rate and systolic blood pressure, temperature, hemoglobin and arterial lactate, use of mechanical ventilation, presence of traumatic brain injury (TBI), initial Glasgow Coma Scale score, Injury Severity Score (ISS), American Society of Anesthesiologists physical health class > I, and presence of hemorrhagic shock). RESULTS:A total of 5912 patients were analyzed. The median age was 39 [26-55] years and 78% were male. More than half (53%) of the patients had an ISS above 15, and 32% had traumatic brain injury. On univariate analysis, the in-hospital mortality was higher in hyperoxemic patients compared to normoxemic patients (12% versus 9%, p?<?0.0001). However, after propensity score matching, we found a significantly lower in-hospital mortality in hyperoxemic patients compared to normoxemic patients (OR 0.59 [0.50-0.70], p <?0.0001). CONCLUSION:In this large observational study, early hyperoxemia in trauma patients was associated with reduced adjusted in-hospital mortality. This result contrasts the unadjusted in-hospital mortality as well as numerous other findings reported in acutely and critically ill patients. The study calls for a randomized clinical trial to further investigate this association.

Dataset Information

Long-Term Antithrombotic Treatments Prescribed for Cardiovascular Diseases in Patients with Hemophilia: Results from the French Registry.

Publications

Long-Term Antithrombotic Treatments Prescribed for Cardiovascular Diseases in Patients with Hemophilia: Results from the French Registry.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets