Therapeutic problems in elderly patients with hemophilia

Since the introduction of clotting factor concentrates, the life expectancy of patients with hemophilia has increased from 40 years in the 1960s to 60 or even 70 years today. In Poland, almost all elderly patients with hemophilia have arthropathy, the majority are infected with hepatitis C virus (HCV), and some even with hepatitis B or human immunodeficiency virus. Liver cirrhosis associated with HCV infection develops within 15 to 20 years in 20% to 30% of these patients. Coexistent diseases related to aging and affecting the heart, kidneys, and other organs constitute another challenge. To prevent ischemic heart disease, cardiovascular risk factors should be carefully monitored. The present paper describes the current recommendations for the use of antithrombotic therapy for acute coronary syndromes and atrial fibrillation in patients with hemophilia. Changes in the urinary system in hemophiliacs develop with age, often leading to dialysis. There is an urgent need for intensive physiotherapy and improved access to orthopedic treatment for patients with arthropathy. High-risk surgical procedures in these patients should be performed in specialized centers with an experienced team and a coagulation laboratory. Older patients with mild hemophilia are at an increased risk for inhibitor development following intensive factor replacement therapy for surgical or invasive procedures. Pain control is a particular challenge due to contraindications to the use of many effective analgesics; another concern is the quality of life of these patients. An increasing number of older patients with hemophilia requires a comprehensive diagnostic and therapeutic approach, preferably at hematological centers.