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

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Scopus)
21 Downloads (Pure)


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
Publication statusPublished - 2 Mar 2023

Bibliographical note

This study was funded by Bayer. L.H.B is funded by the
OPTI-CLOT/To-WiN studies and the SYMPHONY consortium. The SYMPHONY consortium aims to orchestrate
personalized treatment in people with bleeding disorders, and is a unique collaboration between patients,
health care professionals, and translational and fundamental researchers specialized in inherited bleeding disorders, as well as experts from multiple disciplines. It
aims to identify the best treatment choice for each individual based on bleeding phenotype. In order to achieve
this goal, workpackages have been organized according to
three themes, e.g. Diagnostics (workpackage 3 and 4);
Treatment (workpackages 5–9), and Fundamental Research (workpackages 10–12). This research received
funding from the Netherlands Organization for Scientific
Research (NWO) in the framework of the NWA-ORC Call
grant agreement NWA.1160.18.038. Principal investigator: Dr. M. H. Cnossen; project coordinator: Dr. S. H.
Beneficiaries of the SYMPHONY consortium: Erasmus
University Medical Center-Sophia Children’s Hospital,
project leadership and coordination; Sanquin Diagnostics; Sanquin Research; Amsterdam University Medical
Centers; University Medical Center Groningen; University
Medical Center Utrecht; Leiden University Medical Center; Radboud University Medical Center; Netherlands
Society of Hemophilia Patients (NVHP); Netherlands Society for Thrombosis and Hemostasis (NVTH); Bayer B.V.,
CSL Behring B.V., and Swedish Orphan Biovitrum
(Belgium) BVBA/SPRL.

Publisher Copyright:
© 2022 This article is protected by copyright. All rights reserved.


Dive into the research topics of 'Association between sports participation, factor VIII levels and bleeding in hemophilia A'. Together they form a unique fingerprint.

Cite this