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Aging with a Bleeding Disorder and Inhibitor

Older people with this hemophilia complication face some unique challenges
Author: Linda Childers

Getting older often means becoming more vulnerable to certain medical conditions such as arthritis, heart disease, diabetes and high blood pressure. Having hemophilia, especially with an inhibitor, can make treating both the hemophilia and age-related health conditions more challenging.

Although newer medications and treatments have improved life expectancy and quality of life for many people who have an inhibitor, Rebecca Kruse-Jarres, MD, MPH, a hematologist and medical director for the Washington Center for Bleeding Disorders in Seattle, says more research needs to be completed in order to devise evidence-based guidelines on how to treat older patients who have an inhibitor and other age-related ailments.

“People with hemophilia are at risk of developing the same age-related diseases as the rest of the population,” says Kruse-Jarres. “The challenge in treating patients with an inhibitor is that we need to determine how to best manage their individual condition, while also ensuring they don’t have bleeding complications.”

Some of the age-related conditions that can pose particular challenges for people with an inhibitor include:

Atrial fibrillation (AFib), heart disease and cancer

Since the number of adults who develop AFib, an abnormal heart rhythm, increases with age, Kruse-Jarres says it is not uncommon to treat patients who have both AFib and an inhibitor.

“One of the treatments for AFib is either aspirin or an anticoagulant (blood thinner), since AFib can increase a person’s risk of stroke,” Kruse-Jarres says. “But for patients with a bleeding disorder and an inhibitor, it’s important to assess both their clotting (stroke) risk and their bleeding risk.”

“In a hemophilia patient with AFib, we might weigh the frequency and severity of their bleeding risk against whether taking a low-dose aspirin or anticoagulant would significantly lower their stroke risk,” Kruse-Jarres says. “As hematologists, we work closely with a patient’s cardiologist or other specialist to devise a plan of care that might even include surgery done with proper precautions.”

Blood thinners are also used for patients at risk of heart attacks, and for preventing blood clots in cancer patients. Kruse-Jarres says the benefit of prescribing them to patients with an inhibitor must outweigh the risk of not treating the condition.

Broken bones

As people age, their chances of suffering from osteoporosis and bone fractures increase. Kruse-Jarres states that one study has shown that falls are more common in patients with hemophilia over the general population.

“Fall prevention is important,” says Kruse-Jarres. “Balance training in the form of exercise classes, tai chi or yoga can help prevent falls that could result in fractures. Some of those fractures need surgeries, which carries a higher risk of bleeding and infection for hemophilia patients.”

To reduce the risk of developing health conditions such as heart disease, cancer and thin bones later in life, Kruse-Jarres also recommends her patients eat a healthy diet.