Association between sports participation, factor VIII levels and bleeding in hemophilia A

Laura Bukkems, Olav Versloot, M Cnossen, Siv Jonsson, Mats Karlsson, Ron A Mathôt, Kathelijn Fischer*

*Corresponding author for this work

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Background Little is known on how sports participation affects bleeding risk in hemophilia. This study aimed to examine associations between sports participation, factor VIII (FVIII) levels and bleeding in persons with hemophilia A. Methods In this observational, prospective, single-center study, persons with hemophilia A who regularly participated in sports were followed for 12 months. The associations of patient characteristics, FVIII levels, and type/frequency of sports participation with bleeding were analyzed by repeated time-to-event modelling. Results One hundred and twelve persons (median age: 24 years [interquartile range:16 34], 49% severe, 49% on prophylaxis) were included. During follow-up, 70 bleeds of which 20 sports-induced were observed. FVIII levels were inversely correlated with the bleeding hazard; a 50% reduction of the baseline bleeding hazard was observed at FVIII levels of 3.1 and a 90% reduction at 28.0 IU/dL. The bleeding hazard did not correlate with sports participation. In addition, severe hemophilia, prestudy annual bleeding rate, and presence of arthropathy showed a positive association with the bleeding hazard. Conclusion This analysis showed that FVIII levels were an important determinant of the bleeding hazard, but sports participation was not. This observation most likely reflects the presence of adequate FVIII levels during sports participation in our study. Persons with severe hemophilia A exhibited a higher bleeding hazard at a similar FVIII levels than nonsevere, suggesting that the time spent at lower FVIII levels impacts overall bleeding hazard. These data may be used to counsel persons with hemophilia regarding sports participation and the necessity of adequate prophylaxis.

Original languageEnglish
Pages (from-to)317-325
Number of pages9
JournalThrombosis and Haemostasis
Issue number3
Early online date19 Nov 2022
Publication statusPublished - 2 Mar 2023


  • bleeding
  • hemophilia A
  • prophylaxis
  • repeated time-to-event
  • sports


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