OC 29.5 - Outcomes of COVID-19 in persons with hemophilia: a propensity score matched cohort study from a US-based national COVID registry

Background: An acquired hypercoagulable state plays a pivotal role in COVID-19 pathogenesis. It is unclear if the hypocoagulable milieu in persons with hemophilia (PwH) offers biologic protection against COVID-19 severity.

Aims: 1.Determine if hemophilia reduces the risk of COVID-19 severity and venous thromboembolism (VTE) risk.
2.Examine risk-factors and clinical outcomes of COVID-19 among PwH.

Methods: This 1:3 propensity-score (PS) matched cohort study using a national COVID registry and included COVID-19 patients with (n=300) and without hemophilia A/B (n=900) from 01/01/2020 through 01/31/2022. Outcomes studied included: severe COVID-19, 30-day all-cause mortality, VTE and bleeding events [CNS and non-CNS].

Results: The majority of outcomes -severe COVID-19 [ < 3.3% each], mortality (5.3% versus 4.3%], VTE [3.8% versus < 3.3%], CNS-bleeding [ < 2% each]-were comparable between those with and without hemophilia except hospitalization and non-CNS bleeding rates were significantly higher in PwH (Table 1). Hemophilia did not alleviate risk of adverse outcomes- severe COVID-19 and mortality- (OR 1.32, 95% CI 0.74-2.31) and VTE (OR 1.14, 95% CI 0.44-2.67) but significantly increased bleeding risk (OR 4.78,95% CI 2.98-7.48). Older age (OR 1.03 per year, 95% CI 1.02-1.05), heart failure (OR 3.53, 95% CI 1.97-6.31), moderate liver disease (OR 7.05, 95% CI 3.69-13.4), CNS-hemorrhage (OR 5.39, 95 CI 1.7-16.0) significantly increased odds of adverse outcomes of PS-matched cohorts (p < 0.001) (Table 2). For hemophilia cohort, multiple comorbidities (older age, heart failure, hypertension, dementia, mild/moderate liver disease, cancer/malignancy, renal disease) were significantly associated with adverse outcomes (p < 0.001)(Figure 1). Pre-COVID VTE and anticoagulation use independently increased VTE risk while older age, pre-COVID bleeding, hepatitis C, liver disease and substance abuse increased the bleeding risk in PwH (p < 0.01).

Conclusion(s): PwH were not protected against COVID-19 adverse outcomes and VTE risk compared to the general population but increased bleeding risk. Bleeding comorbidity and established risk-factors for COVID-19 adversely affected COVID-19 outcomes in PwH.