COVID-19: Specifics of Care for Individuals with Congenital Bleeding Disorders

Current Concerns and Experiences

One major concern, especially at the onset of the pandemic, was the potential reduction in the availability of medicines. Fortunately, experiences to date have shown that this has not occurred in economically developed countries, including the Czech Republic. However, many hemophilia centers have limited care, with a greater focus on telephone check-ups or other remote forms of consultation. When considering treatment adjustments, in many cases, changes have been postponed due to the uncertainty regarding the ability to carefully monitor the patient following treatment modification.

Current experiences do not suggest a higher susceptibility of hemophilia patients to contracting COVID-19 or having a more severe course of the disease. However, for hemophilia patients with specific comorbidities (such as hypertension, HIV infection, or hepatitis), COVID-19 can pose a greater risk.

Issues Related to Bleeding Disorders and COVID-19

Several questions arise regarding possible complications associated with severe COVID-19, which are crucial for managing care for hemophilia patients:

• Are there specific COVID-19 complications associated with congenital bleeding disorders? In the general population, no significant bleeding complications associated with this infection have been reported, but they are estimated to occur in approximately 3% of severe cases. Individuals with bleeding disorders can be expected to have a higher risk of bleeding complications (such as bleeding from the nose and throat, gastrointestinal tract, or those associated with procedures like cannulation, intubation, etc.). Therefore, it is extremely important to inform the care team about the bleeding disorder immediately upon admission to the hospital. If invasive procedures are necessary, it is essential to consider coagulation factor deficiencies. Another risk factor for bleeding can be medications like nonsteroidal anti-inflammatory drugs due to their inhibition of certain platelet functions.
• Is there an increased risk of thromboembolic complications in hemophilia patients? And is antithrombotic prophylaxis commonly used for them? Clear recommendations are not yet available, but it is accepted that standard prophylactic doses of heparin are considered safe for individuals with hemophilia and factor VIII or IX levels > 5%. For full anticoagulation, higher levels are usually required, typically > 20-30%. When considering antithrombotic prophylaxis or treatment, it is necessary to set up replacement therapy to ensure the safest possible anticoagulation.

Vaccination as a Preventive Measure

Vaccination is unequivocally recommended by the World Federation of Hemophilia (WFH) as a preventive measure against severe COVID-19 even for patients with hemophilia. Administering the vaccine intramuscularly is generally considered possible under conditions of non-traumatic application and prophylaxis with factor VIII or IX concentrate. Detailed recommendations regarding the vaccination of hemophilia patients are provided in guidance from international professional societies, whose key points we summarize here.

Conclusion

Data regarding the risk of COVID-19 infection in individuals with hemophilia are still limited. Therefore, it is always necessary to consider the specifics of hemophilia, especially in cases of severe disease courses, and the care of such patients requires a multidisciplinary team.

(eza)

Sources:
1. Coppola A., Tagliaferri A., Rivolta G. F. et al. Confronting COVID-19: Issues in Hemophilia and Congenital Bleeding Disorders. Semin Thromb Hemost 2020 Oct; 46 (7): 819-822, doi: 10.1055/s-0040-1712961.
2. COVID-19 Vaccination Guidance for People with Bleeding Disorders. World Federation of Hemophilia, 2020 Dec 22. Available at https://news.wfh.org/covid-19-vaccination-guidance-for-people-with-bleeding-disorders.