COVID-19 outcomes in persons with hemophilia: results from a US-based national COVID-19 surveillance registry

National COVID Cohort Collaborative Consortium; Anjali Sharathkumar; Linder Wendt; Chris Ortman; Ragha Srinivasan; Christopher G. Chute; Elizabeth Chrischilles; Clifford M. Takemoto; Adam B. Wilcox; Adam M. Lee; Alexis Graves; Alfred (Jerrod) Anzalone; Amin Manna; Amit Saha; Amy Olex; Andrea Zhou; Andrew E. Williams; Andrew Southerland; Andrew T. Girvin; Anita Walden; Anjali A. Sharathkumar; Benjamin Amor; Benjamin Bates; Brian Hendricks; Brijesh Patel; Caleb Alexander; Carolyn Bramante; Cavin Ward-Caviness; Charisse Madlock-Brown; Christine Suver; Christopher Chute; Christopher Dillon; Chunlei Wu; Clare Schmitt; Cliff Takemoto; Dan Housman; Davera Gabriel; David A. Eichmann; Diego Mazzotti; Don Brown; Eilis Boudreau; Elaine Hill; Elizabeth Zampino; Emily Carlson Marti; Emily R. Pfaff; Evan French; Farrukh M. Koraishy; Federico Mariona; Fred Prior; George Sokos; Greg Martin; Harold Lehmann; Heidi Spratt; Hemalkumar Mehta; Hongfang Liu; Hythem Sidky; J. W.Awori Hayanga; Jami Pincavitch; Jaylyn Clark; Jeremy Richard Harper; Jessica Islam; Jin Ge; Joel Gagnier; Joel H. Saltz; Joel Saltz; Johanna Loomba; John Buse; Jomol Mathew; Joni L. Rutter; Julie A. McMurry; Justin Guinney; Justin Starren; Karen Crowley; Katie Rebecca Bradwell; Kellie M. Walters; Ken Wilkins; Kenneth R. Gersing; Kenrick Dwain Cato; Kimberly Murray; Kristin Kostka; Lavance Northington; Lee Allan Pyles; Leonie Misquitta; Lesley Cottrell; Lili Portilla; Mariam Deacy; Mark M. Bissell; Marshall Clark; Mary Emmett; Mary Morrison Saltz; Matvey B. Palchuk; Melissa A. Haendel; Meredith Adams; Meredith Temple-O'Connor; Michael G. Kurilla; Michele Morris; Nabeel Qureshi; Nasia Safdar; Nicole Garbarini; Noha Sharafeldin; Ofer Sadan; Patricia A. Francis; Penny Wung Burgoon; Peter Robinson; Philip R.O. Payne; Rafael Fuentes; Randeep Jawa; Rebecca Erwin-Cohen; Rena Patel; Richard A. Moffitt; Richard L. Zhu; Rishi Kamaleswaran; Robert Hurley; Robert T. Miller; Saiju Pyarajan; Sam G. Michael; Samuel Bozzette; Sandeep Mallipattu; Satyanarayana Vedula; Scott Chapman; Shawn T. O'Neil; Soko Setoguchi; Stephanie S. Hong; Steve Johnson; Tellen D. Bennett; Tiffany Callahan; Umit Topaloglu; Usman Sheikh; Valery Gordon; Vignesh Subbian; Warren A. Kibbe; Wenndy Hernandez; Will Beasley; Will Cooper; William Hillegass; Xiaohan Tanner Zhang

doi:10.1016/j.jtha.2023.04.040

COVID-19 outcomes in persons with hemophilia: results from a US-based national COVID-19 surveillance registry

National COVID Cohort Collaborative Consortium, Anjali Sharathkumar, Linder Wendt, Chris Ortman, Ragha Srinivasan, Christopher G. Chute, Elizabeth Chrischilles, Clifford M. Takemoto, Adam B. Wilcox, Adam M. Lee, Alexis Graves, Alfred (Jerrod) Anzalone, Amin Manna, Amit Saha, Amy Olex, Andrea Zhou, Andrew E. Williams, Andrew Southerland, Andrew T. Girvin, Anita WaldenAnjali A. Sharathkumar, Benjamin Amor, Benjamin Bates, Brian Hendricks, Brijesh Patel, Caleb Alexander, Carolyn Bramante, Cavin Ward-Caviness, Charisse Madlock-Brown, Christine Suver, Christopher Chute, Christopher Dillon, Chunlei Wu, Clare Schmitt, Cliff Takemoto, Dan Housman, Davera Gabriel, David A. Eichmann, Diego Mazzotti, Don Brown, Eilis Boudreau, Elaine Hill, Elizabeth Zampino, Emily Carlson Marti, Emily R. Pfaff, Evan French, Farrukh M. Koraishy, Federico Mariona, Fred Prior, George Sokos, Greg Martin, Harold Lehmann, Heidi Spratt, Hemalkumar Mehta, Hongfang Liu, Hythem Sidky, J. W.Awori Hayanga, Jami Pincavitch, Jaylyn Clark, Jeremy Richard Harper, Jessica Islam, Jin Ge, Joel Gagnier, Joel H. Saltz, Joel Saltz, Johanna Loomba, John Buse, Jomol Mathew, Joni L. Rutter, Julie A. McMurry, Justin Guinney, Justin Starren, Karen Crowley, Katie Rebecca Bradwell, Kellie M. Walters, Ken Wilkins, Kenneth R. Gersing, Kenrick Dwain Cato, Kimberly Murray, Kristin Kostka, Lavance Northington, Lee Allan Pyles, Leonie Misquitta, Lesley Cottrell, Lili Portilla, Mariam Deacy, Mark M. Bissell, Marshall Clark, Mary Emmett, Mary Morrison Saltz, Matvey B. Palchuk, Melissa A. Haendel, Meredith Adams, Meredith Temple-O'Connor, Michael G. Kurilla, Michele Morris, Nabeel Qureshi, Nasia Safdar, Nicole Garbarini, Noha Sharafeldin, Ofer Sadan, Patricia A. Francis, Penny Wung Burgoon, Peter Robinson, Philip R.O. Payne, Rafael Fuentes, Randeep Jawa, Rebecca Erwin-Cohen, Rena Patel, Richard A. Moffitt, Richard L. Zhu, Rishi Kamaleswaran, Robert Hurley, Robert T. Miller, Saiju Pyarajan, Sam G. Michael, Samuel Bozzette, Sandeep Mallipattu, Satyanarayana Vedula, Scott Chapman, Shawn T. O'Neil, Soko Setoguchi, Stephanie S. Hong, Steve Johnson, Tellen D. Bennett, Tiffany Callahan, Umit Topaloglu, Usman Sheikh, Valery Gordon, Vignesh Subbian, Warren A. Kibbe, Wenndy Hernandez, Will Beasley, Will Cooper, William Hillegass, Xiaohan Tanner Zhang

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

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.

Original language	English
Pages (from-to)	61-75
Number of pages	15
Journal	Journal of Thrombosis and Haemostasis
Volume	22
Issue number	1
DOIs	https://doi.org/10.1016/j.jtha.2023.04.040
State	Published - Jan 2024

Keywords

COVID-19
VTE
health outcomes
hemophilia
mortality
outcomes
venous thromboembolism

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10.1016/j.jtha.2023.04.040

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National COVID Cohort Collaborative Consortium, Sharathkumar, A., Wendt, L., Ortman, C., Srinivasan, R., Chute, C. G., Chrischilles, E., Takemoto, C. M., Wilcox, A. B., Lee, A. M., Graves, A., Anzalone, A., Manna, A., Saha, A., Olex, A., Zhou, A., Williams, A. E., Southerland, A., Girvin, A. T., ... Zhang, X. T. (2024). COVID-19 outcomes in persons with hemophilia: results from a US-based national COVID-19 surveillance registry. Journal of Thrombosis and Haemostasis, 22(1), 61-75. https://doi.org/10.1016/j.jtha.2023.04.040

@article{55c9e15740e14b048014656872b889bf,

title = "COVID-19 outcomes in persons with hemophilia: results from a US-based national COVID-19 surveillance registry",

abstract = "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.",

keywords = "COVID-19, VTE, health outcomes, hemophilia, mortality, outcomes, venous thromboembolism",

author = "{National COVID Cohort Collaborative Consortium} and Anjali Sharathkumar and Linder Wendt and Chris Ortman and Ragha Srinivasan and Chute, {Christopher G.} and Elizabeth Chrischilles and Takemoto, {Clifford M.} and Wilcox, {Adam B.} and Lee, {Adam M.} and Alexis Graves and Anzalone, {Alfred (Jerrod)} and Amin Manna and Amit Saha and Amy Olex and Andrea Zhou and Williams, {Andrew E.} and Andrew Southerland and Girvin, {Andrew T.} and Anita Walden and Sharathkumar, {Anjali A.} and Benjamin Amor and Benjamin Bates and Brian Hendricks and Brijesh Patel and Caleb Alexander and Carolyn Bramante and Cavin Ward-Caviness and Charisse Madlock-Brown and Christine Suver and Christopher Chute and Christopher Dillon and Chunlei Wu and Clare Schmitt and Cliff Takemoto and Dan Housman and Davera Gabriel and Eichmann, {David A.} and Diego Mazzotti and Don Brown and Eilis Boudreau and Elaine Hill and Elizabeth Zampino and Marti, {Emily Carlson} and Pfaff, {Emily R.} and Evan French and Koraishy, {Farrukh M.} and Federico Mariona and Fred Prior and George Sokos and Greg Martin and Harold Lehmann and Heidi Spratt and Hemalkumar Mehta and Hongfang Liu and Hythem Sidky and Hayanga, {J. W.Awori} and Jami Pincavitch and Jaylyn Clark and Harper, {Jeremy Richard} and Jessica Islam and Jin Ge and Joel Gagnier and Saltz, {Joel H.} and Joel Saltz and Johanna Loomba and John Buse and Jomol Mathew and Rutter, {Joni L.} and McMurry, {Julie A.} and Justin Guinney and Justin Starren and Karen Crowley and Bradwell, {Katie Rebecca} and Walters, {Kellie M.} and Ken Wilkins and Gersing, {Kenneth R.} and Cato, {Kenrick Dwain} and Kimberly Murray and Kristin Kostka and Lavance Northington and Pyles, {Lee Allan} and Leonie Misquitta and Lesley Cottrell and Lili Portilla and Mariam Deacy and Bissell, {Mark M.} and Marshall Clark and Mary Emmett and Saltz, {Mary Morrison} and Palchuk, {Matvey B.} and Haendel, {Melissa A.} and Meredith Adams and Meredith Temple-O'Connor and Kurilla, {Michael G.} and Michele Morris and Nabeel Qureshi and Nasia Safdar and Nicole Garbarini and Noha Sharafeldin and Ofer Sadan and Francis, {Patricia A.} and Burgoon, {Penny Wung} and Peter Robinson and Payne, {Philip R.O.} and Rafael Fuentes and Randeep Jawa and Rebecca Erwin-Cohen and Rena Patel and Moffitt, {Richard A.} and Zhu, {Richard L.} and Rishi Kamaleswaran and Robert Hurley and Miller, {Robert T.} and Saiju Pyarajan and Michael, {Sam G.} and Samuel Bozzette and Sandeep Mallipattu and Satyanarayana Vedula and Scott Chapman and O'Neil, {Shawn T.} and Soko Setoguchi and Hong, {Stephanie S.} and Steve Johnson and Bennett, {Tellen D.} and Tiffany Callahan and Umit Topaloglu and Usman Sheikh and Valery Gordon and Vignesh Subbian and Kibbe, {Warren A.} and Wenndy Hernandez and Will Beasley and Will Cooper and William Hillegass and Zhang, {Xiaohan Tanner}",

note = "Publisher Copyright: {\textcopyright} 2023 International Society on Thrombosis and Haemostasis",

year = "2024",

month = jan,

doi = "10.1016/j.jtha.2023.04.040",

language = "English",

volume = "22",

pages = "61--75",

journal = "Journal of Thrombosis and Haemostasis",

issn = "1538-7933",

number = "1",

}

National COVID Cohort Collaborative Consortium, Sharathkumar, A, Wendt, L, Ortman, C, Srinivasan, R, Chute, CG, Chrischilles, E, Takemoto, CM, Wilcox, AB, Lee, AM, Graves, A, Anzalone, A, Manna, A, Saha, A, Olex, A, Zhou, A, Williams, AE, Southerland, A, Girvin, AT, Walden, A, Sharathkumar, AA, Amor, B, Bates, B, Hendricks, B, Patel, B, Alexander, C, Bramante, C, Ward-Caviness, C, Madlock-Brown, C, Suver, C, Chute, C, Dillon, C, Wu, C, Schmitt, C, Takemoto, C, Housman, D, Gabriel, D, Eichmann, DA, Mazzotti, D, Brown, D, Boudreau, E, Hill, E, Zampino, E, Marti, EC, Pfaff, ER, French, E, Koraishy, FM, Mariona, F, Prior, F, Sokos, G, Martin, G, Lehmann, H, Spratt, H, Mehta, H, Liu, H, Sidky, H, Hayanga, JWA, Pincavitch, J, Clark, J, Harper, JR, Islam, J, Ge, J, Gagnier, J, Saltz, JH, Saltz, J, Loomba, J, Buse, J, Mathew, J, Rutter, JL, McMurry, JA, Guinney, J, Starren, J, Crowley, K, Bradwell, KR, Walters, KM, Wilkins, K, Gersing, KR, Cato, KD, Murray, K, Kostka, K, Northington, L, Pyles, LA, Misquitta, L, Cottrell, L, Portilla, L, Deacy, M, Bissell, MM, Clark, M, Emmett, M, Saltz, MM, Palchuk, MB, Haendel, MA, Adams, M, Temple-O'Connor, M, Kurilla, MG, Morris, M, Qureshi, N, Safdar, N, Garbarini, N, Sharafeldin, N, Sadan, O, Francis, PA, Burgoon, PW, Robinson, P, Payne, PRO, Fuentes, R, Jawa, R, Erwin-Cohen, R, Patel, R, Moffitt, RA, Zhu, RL, Kamaleswaran, R, Hurley, R, Miller, RT, Pyarajan, S, Michael, SG, Bozzette, S, Mallipattu, S, Vedula, S, Chapman, S, O'Neil, ST, Setoguchi, S, Hong, SS, Johnson, S, Bennett, TD, Callahan, T, Topaloglu, U, Sheikh, U, Gordon, V, Subbian, V, Kibbe, WA, Hernandez, W, Beasley, W, Cooper, W, Hillegass, W & Zhang, XT 2024, 'COVID-19 outcomes in persons with hemophilia: results from a US-based national COVID-19 surveillance registry', Journal of Thrombosis and Haemostasis, vol. 22, no. 1, pp. 61-75. https://doi.org/10.1016/j.jtha.2023.04.040

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

AU - Lehmann, Harold

AU - Spratt, Heidi

AU - Mehta, Hemalkumar

AU - Liu, Hongfang

AU - Sidky, Hythem

AU - Hayanga, J. W.Awori

AU - Pincavitch, Jami

AU - Clark, Jaylyn

AU - Harper, Jeremy Richard

AU - Islam, Jessica

AU - Ge, Jin

AU - Gagnier, Joel

AU - Saltz, Joel H.

AU - Saltz, Joel

AU - Loomba, Johanna

AU - Buse, John

AU - Mathew, Jomol

AU - Rutter, Joni L.

AU - McMurry, Julie A.

AU - Guinney, Justin

AU - Starren, Justin

AU - Crowley, Karen

AU - Bradwell, Katie Rebecca

AU - Walters, Kellie M.

AU - Wilkins, Ken

AU - Gersing, Kenneth R.

AU - Cato, Kenrick Dwain

AU - Murray, Kimberly

AU - Kostka, Kristin

AU - Northington, Lavance

AU - Pyles, Lee Allan

AU - Misquitta, Leonie

AU - Cottrell, Lesley

AU - Portilla, Lili

AU - Deacy, Mariam

AU - Bissell, Mark M.

AU - Clark, Marshall

AU - Emmett, Mary

AU - Saltz, Mary Morrison

AU - Palchuk, Matvey B.

AU - Haendel, Melissa A.

AU - Adams, Meredith

AU - Temple-O'Connor, Meredith

AU - Kurilla, Michael G.

AU - Morris, Michele

AU - Qureshi, Nabeel

AU - Safdar, Nasia

AU - Garbarini, Nicole

AU - Sharafeldin, Noha

AU - Sadan, Ofer

AU - Francis, Patricia A.

AU - Burgoon, Penny Wung

AU - Robinson, Peter

AU - Payne, Philip R.O.

AU - Fuentes, Rafael

AU - Jawa, Randeep

AU - Erwin-Cohen, Rebecca

AU - Patel, Rena

AU - Moffitt, Richard A.

AU - Zhu, Richard L.

AU - Kamaleswaran, Rishi

AU - Hurley, Robert

AU - Miller, Robert T.

AU - Pyarajan, Saiju

AU - Michael, Sam G.

AU - Bozzette, Samuel

AU - Mallipattu, Sandeep

AU - Vedula, Satyanarayana

AU - Chapman, Scott

AU - O'Neil, Shawn T.

AU - Setoguchi, Soko

AU - Hong, Stephanie S.

AU - Johnson, Steve

AU - Bennett, Tellen D.

AU - Callahan, Tiffany

AU - Topaloglu, Umit

AU - Sheikh, Usman

AU - Gordon, Valery

AU - Subbian, Vignesh

AU - Kibbe, Warren A.

AU - Hernandez, Wenndy

AU - Beasley, Will

AU - Cooper, Will

AU - Hillegass, William

AU - Zhang, Xiaohan Tanner

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

UR - http://www.scopus.com/inward/record.url?scp=85173051861&partnerID=8YFLogxK

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 -

COVID-19 outcomes in persons with hemophilia: results from a US-based national COVID-19 surveillance registry

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