This article is a U.S. Government work and, as such, is in the public domain in the United States of America.
Changes in the occurrence of and risk factors for hemophilia-associated intracranial hemorrhage†
Article first published online: 30 JUL 2001
Published 2001 Wiley-Liss, Inc.
American Journal of Hematology
Volume 68, Issue 1, pages 37–42, September 2001
How to Cite
Nuss, R., Soucie, J. M. and Evatt, B. (2001), Changes in the occurrence of and risk factors for hemophilia-associated intracranial hemorrhage. Am. J. Hematol., 68: 37–42. doi: 10.1002/ajh.1146
- Issue published online: 30 JUL 2001
- Article first published online: 30 JUL 2001
- Manuscript Accepted: 15 MAY 2001
- Manuscript Received: 21 SEP 2000
- bleeding disorder;
- intracranial hemorrhage;
- public health;
- factor VIII deficiency;
- factor IX deficiency;
Recent studies suggest that rates of intracranial hemorrhage (ICH) increased concomitant with the HIV epidemic among the hemophilia population, but no studies have directly examined factors associated with ICH. To determine ICH rates and identify factors associated with ICH, we performed a nested case–control study of a cohort composed of all hemophilic males identified by a surveillance system. Data were obtained from medical records of care received during 1993–1997. Patients with ICH listed in hospital records or on death certificates during the 5-year period were compared to the remainder of the cohort to examine associations between ICH and patients' demographic and clinical factors including the presence of HIV infection. Among the 3,269 males in the cohort, 88 (2.7%) had an ICH during follow-up, an average incidence rate of 0.0054 case/year. Hemorrhage sites were intracerebral for 37.5%, subdural for 34.1%, unspecified for 19.3%, subarachnoid for 12.5%, and epidural for 8% of cases. For 22% of cases, the ICH was trauma-related, and, overall, 16 patients (18.2%) died. Several factors were independently associated with ICH (odds ratio, P value): severe disease (2.0, 0.05); age 51+ years compared to 6–10 year olds (3.7, 0.02); presence of an inhibitor (3.5, <0.001); and HIV infection among whites only (4.0, <0.001). ICH rates in our cohort were 2-fold higher compared to rates from previous reports. Much of the increase was attributed to HIV infection, which raised ICH risk primarily in whites and was frequently associated with spontaneous ICH among older individuals. Am. J. Hematol. 68:37–42, 2001. Published 2001 Wiley-Liss, Inc.