Abstract Number: PB1242
Meeting: ISTH 2020 Congress
Background: In a previous study (Kumar et al. Thromb Haemost; 2016), we documented a 2.3 fold increase in FVIII activity (FVIII:C) in adolescent males with mild hemophilia A (n=8) performing moderate-intensity aerobic-exercise
Aims: In this pilot-study, we investigated the impact of MIA-exercise on hemostasis in adolescent, hemophilia A carriers.
Methods: The study (clinicaltrials.gov: NCT03379974) was approved by the research ethics committee. 5 females who met eligibility criteria were invited to participate. Written consent/assent was obtained from parent/participant. After baseline (T0) blood work was drawn, participants were instructed to exercise on a cycle-ergometer using the previously-validated, progressively incremental Godfrey protocol, until they completed 3-minutes of cycling at 85 % of their predicted maximum heart-rate. Blood work was repeated at 30 (T1), 75 (T3) and 135 (T4) minutes from the start of exercise. Specimens were assessed for multiple coagulation labs including global hemostatic assays.
Results: Baseline demographic data are summarized in Table 1. All participants successfully completed the study protocol. Median (range) duration of exercise was 11 (10-15) minutes. MIA-exercise was associated with a 1.06
(1.0-1.9) fold change in FVIII:C (T1 compared to baseline), 0.94 (0.8-1.4) fold change in von Willebrand antigen (VWF:Ag), 1.03 (0.8-1.6) fold change in VWF activity, 1 (0.8-1.8) fold change in platelet count and 1.06 (1.01-1.14) fold change in endogenous-thrombin-potential. We additionally compared the FVIII:C and VWF:Ag changes associated with MIA-exercise to the participant’s historic desmopressin-challenge (Figure 1). FVIII:C and VWF:Ag changes associated with exercise were observed to be inferior to desmopressin.
Conclusions: This is the first study to investigate the impact of aerobic-exercise on hemostasis in carriers of hemophilia A. Despite exercising for a similar duration and intensity as males with mild hemophilia A, females did not show a significant increase in FVIII:C, VWF:Ag or platelet counts. Future directions include confirmation of this gender-based discrepancy and further investigation of its etiology.
|Characteristics||Participant 1||Participant 2||Participant 3||Participant 4||Participant 5|
|Body mass index (kg/m2)||18.7||26.7||20.7||23.5||19.2|
|Baseline FVIII:C (%)||57||24||54||60||52|
|F8 variant identified||c.3808insA||c.1910A>G||c.1034T>C||c.1034T>C||c.6445G>T|
|Severity of hemophilia reported with F8 mutation||Severe||Mild/Severe||Moderate||Moderate||Mild|
|Historic desmopressin response||Responder||Responder||Responder||Responder||Responder|
|Baseline Physical Activity (measured using IPAQ)||High||High||High||High||Moderate|
|Duration of exercise (min)||15||12||10||11||11|
[Table 1: Baseline characteristics of study cohort]
To cite this abstract in AMA style:Kumar R, Carcao M, Gonzales A, Lischak J, Widener P, Stanek J, Waller A, Kerlin B, Kahr W, Rand M, Lillicrap D, Dunn A. Impact of a Standardized, Moderate-Intensity Aerobic Exercise Regimen on Hemostasis in Adolescent Hemophilia A Carriers: A Pilot Investigation [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/impact-of-a-standardized-moderate-intensity-aerobic-exercise-regimen-on-hemostasis-in-adolescent-hemophilia-a-carriers-a-pilot-investigation/. Accessed November 26, 2020.
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