PO075 | HEMOSTATIC AND CARDIOVASCULAR PROFILES IN HEMOPHILIA PATIENTS WITH AND WITHOUT ATHEROSCLEROSIS

A. Napolitano, E. Zanon, L. Spiezia, G. Camporese, P. Scarinzi, F. Ahmad, G. Saggiorato, C. Bulato, F. Sartorello, S. Toffanin, A. Montagna, V. Azzaro, C. Simion, E. Campello, P. Simioni | Department of Medicine, University of Padova, Italy

Background and Aims. Hemophilia is classically characterized by hypocoagulability; however, patients remain susceptible to atherosclerosis due to the presence of conventional cardiovascular risk factors. Data on global hemostasis and platelet function in hemophilia patients with arterial disease are still limited. This study aimed to compare clinical characteristics, laboratory parameters, ROTEM findings, and platelet function between hemophilia patients with and without atherosclerosis, and to explore potential differences in their hemostatic profiles.
Methods. This cross-sectional study included 105 adult patients with hemophilia A and B, of whom 77 had no evidence of atherosclerosis and 28 had atherosclerosis. Atherosclerosis was defined as ≥50% carotid artery stenosis on Doppler ultrasound, the presence of any aortic plaque on imaging, or a pathological ankle–brachial index (ABI ≤ 0.9) consistent with peripheral arterial disease. Clinical history, comorbidities, medications, laboratory parameters, ROTEM, and Multiplate assays were collected. Continuous variables were expressed as mean ± standard deviation or median [IQR], and categorical variables as counts and percentages. Group comparisons were performed using the t-test, Mann–Whitney U test, or chi-square test, with p < 0.05 considered statistically significant.
Results. Patients with atherosclerosis were older than those without (63 ± 12.4 vs. 55.5 ± 10.9 years; p = 0.007) and showed a higher prevalence of hypertension (60.7% vs. 33.7%; p = 0.013), dyslipidemia (75% vs. 35%; p < 0.001), use of antihypertensive therapy (53.6% vs. 28.6%; p = 0.018), lipid-lowering therapy (46.4% vs. 16.9%; p = 0.002), and prior cardiovascular or cerebrovascular events (28.6% vs. 6.5%; p = 0.002). No significant differences were observed in hemophilia type or severity, obesity, diabetes, alcohol consumption, or presence of inhibitors. Routine laboratory parameters, including hemoglobin, platelet count, renal function, lipid profile, lipoprotein(a), hs-CRP, and HbA1c, were comparable between groups. NT-proBNP differed significantly between groups but remained within normal ranges. ROTEM analysis showed a shortened INTEM clotting time in patients with atherosclerosis (254.9 ± 47.8 vs. 294.3 ± 140.1 s; p = 0.04) and increased FIBTEM maximum clot firmness (14 ± 3.7 vs. 12.2 ± 3.6 mm; p = 0.031), suggesting subtle procoagulant changes. No significant differences were observed in EXTEM parameters or in Multiplate ADP and ASPI assays, indicating preserved platelet function (Table 1). Kaplan–Meier analysis showed no significant difference in survival between groups (p = 0.93).
Conclusions. Despite their inherent hypocoagulable state, hemophilia patients with atherosclerosis display a cardiovascular risk profile similar to that of the general population. ROTEM analysis suggests early and subtle shifts toward a procoagulant state, characterized by faster clot initiation and increased fibrin-based clot firmness. These findings highlight the importance of comprehensive cardiovascular risk assessment and global hemostasis evaluation in hemophilia patients, and support ROTEM as a sensitive tool for detecting subclinical prothrombotic changes associated with atherosclerosis.