TY - JOUR
T1 - COVID-19 outcomes in persons with hemophilia
T2 - results from a US-based national COVID-19 surveillance registry
AU - National COVID Cohort Collaborative Consortium
AU - Sharathkumar, Anjali
AU - Wendt, Linder
AU - Ortman, Chris
AU - Srinivasan, Ragha
AU - Chute, Christopher G.
AU - Chrischilles, Elizabeth
AU - Takemoto, Clifford M.
AU - Wilcox, Adam B.
AU - Lee, Adam M.
AU - Graves, Alexis
AU - Anzalone, Alfred (Jerrod)
AU - Manna, Amin
AU - Saha, Amit
AU - Olex, Amy
AU - Zhou, Andrea
AU - Williams, Andrew E.
AU - Southerland, Andrew
AU - Girvin, Andrew T.
AU - Walden, Anita
AU - Sharathkumar, Anjali A.
AU - Amor, Benjamin
AU - Bates, Benjamin
AU - Hendricks, Brian
AU - Patel, Brijesh
AU - Alexander, Caleb
AU - Bramante, Carolyn
AU - Ward-Caviness, Cavin
AU - Madlock-Brown, Charisse
AU - Suver, Christine
AU - Chute, Christopher
AU - Dillon, Christopher
AU - Wu, Chunlei
AU - Schmitt, Clare
AU - Takemoto, Cliff
AU - Housman, Dan
AU - Gabriel, Davera
AU - Eichmann, David A.
AU - Mazzotti, Diego
AU - Brown, Don
AU - Boudreau, Eilis
AU - Hill, Elaine
AU - Zampino, Elizabeth
AU - Marti, Emily Carlson
AU - Pfaff, Emily R.
AU - French, Evan
AU - Koraishy, Farrukh M.
AU - Mariona, Federico
AU - Prior, Fred
AU - Sokos, George
AU - Martin, Greg
N1 - Publisher Copyright:
© 2023 International Society on Thrombosis and Haemostasis
PY - 2024/1
Y1 - 2024/1
N2 - Background: Hypercoagulable state contributing to thrombotic complications worsens COVID-19 severity and outcomes, whereas anticoagulation improves outcomes by alleviating hypercoagulability. Objectives: To examine whether hemophilia, an inherent hypocoagulable condition, offers protection against COVID-19 severity and reduces venous thromboembolism (VTE) risk in persons with hemophilia (PwH). Methods: A 1:3 propensity score–matched retrospective cohort study used national COVID-19 registry data (January 2020 through January 2022) to compare outcomes between 300 male PwH and 900 matched controls without hemophilia. Results: Analyses of PwH demonstrated that known risk factors (older age, heart failure, hypertension, cancer/malignancy, dementia, and renal and liver disease) contributed to severe COVID-19 and/or 30-day all-cause mortality. Non–central nervous system bleeding was an additional risk factor for poor outcomes in PwH. Odds of developing VTE with COVID-19 in PwH were associated with pre-COVID VTE diagnosis (odds ratio [OR], 51.9; 95% CI, 12.8-266; p < .001), anticoagulation therapy (OR, 12.7; 95% CI, 3.01-48.6; p < .001), and pulmonary disease (OR, 16.1; 95% CI, 10.4-25.4; p < .001). Thirty-day all-cause mortality (OR, 1.27; 95% CI, 0.75-2.11; p = .3) and VTE events (OR, 1.32; 95% CI, 0.64-2.73; p = .4) were not significantly different between the matched cohorts; however, hospitalizations (OR, 1.58; 95% CI, 1.20-2.10; p = .001) and non–central nervous system bleeding events (OR, 4.78; 95% CI, 2.98-7.48; p < .001) were increased in PwH. In multivariate analyses, hemophilia did not reduce adverse outcomes (OR, 1.32; 95% CI, 0.74-2.31; p = .2) or VTE (OR, 1.14; 95% CI, 0.44-2.67; p = .8) but increased bleeding risk (OR, 4.70; 95% CI, 2.98-7.48; p < .001). Conclusion: After adjusting for patient characteristics/comorbidities, hemophilia increased bleeding risk with COVID-19 but did not protect against severe disease and VTE.
AB - Background: Hypercoagulable state contributing to thrombotic complications worsens COVID-19 severity and outcomes, whereas anticoagulation improves outcomes by alleviating hypercoagulability. Objectives: To examine whether hemophilia, an inherent hypocoagulable condition, offers protection against COVID-19 severity and reduces venous thromboembolism (VTE) risk in persons with hemophilia (PwH). Methods: A 1:3 propensity score–matched retrospective cohort study used national COVID-19 registry data (January 2020 through January 2022) to compare outcomes between 300 male PwH and 900 matched controls without hemophilia. Results: Analyses of PwH demonstrated that known risk factors (older age, heart failure, hypertension, cancer/malignancy, dementia, and renal and liver disease) contributed to severe COVID-19 and/or 30-day all-cause mortality. Non–central nervous system bleeding was an additional risk factor for poor outcomes in PwH. Odds of developing VTE with COVID-19 in PwH were associated with pre-COVID VTE diagnosis (odds ratio [OR], 51.9; 95% CI, 12.8-266; p < .001), anticoagulation therapy (OR, 12.7; 95% CI, 3.01-48.6; p < .001), and pulmonary disease (OR, 16.1; 95% CI, 10.4-25.4; p < .001). Thirty-day all-cause mortality (OR, 1.27; 95% CI, 0.75-2.11; p = .3) and VTE events (OR, 1.32; 95% CI, 0.64-2.73; p = .4) were not significantly different between the matched cohorts; however, hospitalizations (OR, 1.58; 95% CI, 1.20-2.10; p = .001) and non–central nervous system bleeding events (OR, 4.78; 95% CI, 2.98-7.48; p < .001) were increased in PwH. In multivariate analyses, hemophilia did not reduce adverse outcomes (OR, 1.32; 95% CI, 0.74-2.31; p = .2) or VTE (OR, 1.14; 95% CI, 0.44-2.67; p = .8) but increased bleeding risk (OR, 4.70; 95% CI, 2.98-7.48; p < .001). Conclusion: After adjusting for patient characteristics/comorbidities, hemophilia increased bleeding risk with COVID-19 but did not protect against severe disease and VTE.
KW - COVID-19
KW - VTE
KW - health outcomes
KW - hemophilia
KW - mortality
KW - outcomes
KW - venous thromboembolism
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U2 - 10.1016/j.jtha.2023.04.040
DO - 10.1016/j.jtha.2023.04.040
M3 - Article
C2 - 37182697
AN - SCOPUS:85173051861
SN - 1538-7933
VL - 22
SP - 61
EP - 75
JO - Journal of Thrombosis and Haemostasis
JF - Journal of Thrombosis and Haemostasis
IS - 1
ER -