Publications (15)

  • Lisa Weickert · Stefanie Krekeler · Katrin Nickles · [...] · Wolfgand Miesbach
    [Show abstract] [Hide abstract] ABSTRACT: Oral bleeding is a frequently reported symptom of von Willebrand disease (VWD) and evaluated by several VWD bleeding scores. Gingival bleeding is also known to be a leading symptom of plaque-induced gingivitis and untreated periodontal disease. This study evaluates whether mild type 1 VWD is associated with an increased susceptibility to gingival bleeding. In this case-control study, 50 patients and 40 matched controls were periodontally examined, answered a questionnaire, and underwent professional teeth cleaning. Compared with the controls, the VWD patients more frequently reported periodontal symptoms, such as bleeding (34 vs. 20%, P = 0.141) and swelling (54 vs. 32.5%, P = 0.538) of the gingiva, and these patients had their teeth professionally cleaned less often (58 vs. 77.5%, P = 0.051). However, there was less gingival bleeding, as determined by the gingival bleeding index, in the VWD patients compared with the controls (10 vs. 12.2%, P = 0.047); the amount of bleeding on probing was similar between the VWD patients and the controls (17 vs. 17.2%, P = 0.723). Gingival bleeding in VWD patients may be triggered by gingival inflammation, but it is not a genuine symptom of mild type 1 VWD.
    Article · May 2016 · Blood Coagulation and Fibrinolysis
  • Wolfgang Miesbach · Stefanie Krekeler · Zsuzsanna Wolf · Erhard Seifried
    [Show abstract] [Hide abstract] ABSTRACT: von Willebrand disease (VWD) is caused by dysfunction or diminished levels of von Willebrand factor (VWF). VWF-containing plasma concentrates are used for treatment of patients with VWD for whom desmopressin treatment is insufficient or contraindicated. A single-centre, retrospective observational study over a period of up to 25years was conducted to evaluate the effectiveness and safety profile of Haemate(®) P (CSL Behring, Marburg, Germany), a plasma-derived, purified, pasteurised and lyophilised VWF-containing factor VIII (FVIII) concentrate. The study included 71 patients who had been treated with Haemate(®) P over a period of >5years. A total of 663 treatments with individual laboratory evaluations were recorded. Two patients had both mild type 1 VWD and haemophilia A (HA), three had HA only, 39 had type 1 VWD, 16 had type 2 VWD, nine had type 3 VWD, one had acquired VWD and one had uncategorised VWD. Haemate(®) P treatment indications included bleeding events (37 patients) and surgical interventions (70 patients). Thirteen patients received Haemate(®) P as long-term prophylaxis (n=3), as part of rehabilitation treatment (n=5), or in context of recovery measurements (n=5). Treatment with Haemate(®) P was generally well tolerated; only one thromboembolic event occurred. In cases of bleeding events, Haemate(®) P was haemostatically effective in all patients. Furthermore, during operations where Haemate(®) P was administered, >90% incurred no complications. In this retrospective observational study, Haemate(®) P was shown to be effective and safe for the treatment of VWD in adult patients. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Article · Dec 2014 · Thrombosis Research
  • S Krekeler · S Alesci · W Miesbach
    [Show abstract] [Hide abstract] ABSTRACT: Unlabelled: Thromboembolic complications may occur in patients with major operations even after routine thromboprophylaxis with low-molecular-weight-heparin. In this retrospective, single center survey the post-operative course of patients with haemophilia was investigated. Patients, methods: Overall, the postoperative course in 85 patients with haemophilia A and B (median age: 43 years, 18-73 years) and 139 surgical procedures was analyzed. The surgical procedures mainly consist of major orthopedic surgery (58 total knee replacement, 15 hip replacement, 17 other major orthopedic surgery, 15 minor orthopedic procedures). Additional surgical procedures were abdominal-surgical (18), urological (8), neurosurgical (5). Results: During the post-operative observation period a small number of wound healing complications occurred (4%). None of the patients developed symptomatic deep vein thrombosis or lung embolism. Conclusion: There seems to a decreased risk of postoperative thromboembolism in patients with haemophilia.
    Article · Sep 2012 · Hamostaseologie
  • [Show abstract] [Hide abstract] ABSTRACT: Unlabelled: The retrospective observational study surveys the relationship between development of inhibitors in the treatment of haemophilia patients and risk factors such as changing FVIII products. A total of 119 patients were included in this study, 198 changes of FVIII products were evaluated. Results: During the observation period of 12 months none of the patients developed an inhibitor, which was temporally associated with a change of FVIII products. A frequent change of FVIII products didn't lead to an increase in inhibitor risk. The change between plasmatic and recombinant preparations could not be confirmed as a risk factor. Furthermore, no correlation between treatment regimens, severity, patient age and comorbidities of the patients could be found.
    Article · Sep 2012 · Hamostaseologie
  • S Alesci · S Krekeler · E Seifried · W Miesbach
    Article · Jul 2012 · Haemophilia
  • R Sonja Alesci · Stefanie Krekeler · Erhard Seifried · Wolfgang Miesbach
    [Show abstract] [Hide abstract] ABSTRACT: Arterial hypertension is very common and occurs often in patients with haemophilia A (HA) and von Willebrand disease (VWD) due to their increased life expectancy. Bleeding complications in haemophilia and von Willebrand patients with hypertension so far are not well evaluated. Even data regarding the use of antihypertensive treatment in these patients are lacking. That is why we want to establish a register of the patients regarding the bleeding complications under arterial hypertension. The prevalence of arterial hypertension in our patients' population (n = 258 of >18 years, 121 men, 137 women) was as follow: 190 patients had VWD 1, eight VWD 2A, one VWD 2B, five VWD 3, 39 haemophilia A (two severe, one moderate, 36 mild). All patients (n = 258) had arterial hypertension because this was our issue. Certainly, patients even had more coronary risk factors. One important risk factor was hyperlipoproteinemia (n = 111). Nicotine abuse was rare (nine patients, 3.4%). Adipositas (78 ± 18 kg, range 37-164 kg, median BMI = 23.2 kg/m(2)) as well as obstructive sleep apnoea (two patients) were not common. Regarding the cohort, 57 patients with bleeding disorder and hypertension suffered from coronary artery disease. No major bleeding or ischemic complications were observed. Obviously, patients with haemophilia and VWD with arterial hypertension do not have an increased risk of bleeding. Adequate treatment is necessary. International registers with a larger number of patients can be useful.
    Article · Apr 2012 · Blood coagulation & fibrinolysis: an international journal in haemostasis and thrombosis
  • [Show abstract] [Hide abstract] ABSTRACT: Unlabelled: The retrospective cohort study surveys the influence of age, co-morbidity and laboratory values on FVIII-activity (FVIII:C) in patients with haemophilia A with (mild n = 48, moderate n = 10, severe n = 7 and carriers n = 23). Median observation was 19 years for patients with haemophilia A and 9,5 years for carriers. Results: FVIII:C levels collected from patients with mild haemophilia A displayed a significant median increase of 6.5% with proceeding age (p = 0.0013). Patients with moderate haemophilia A (and carriers of haemophilia A) showed a non significant median increase of 1.05% (carriers 8%). Eight patients showed FVIII:C levels at last blood withdrawal that indicated a change of severity from moderate to mild haemophilia A. A significant correlation was found between FVIII:C and VWF:RCo (p = 0.0203) and AFP (p < 0.0005). The correlation between FVIII:C and triglycerides and LDH was significant negative (p < 0.0005). No significant correlation could be found for FVIII:C and co-morbidity, fibrinogen, cholesterol and VWF:Ag.
    Article · Nov 2011 · Hamostaseologie
  • W Miesbach · S Krekeler · O Dück · [...] · R Grossmann
    [Show abstract] [Hide abstract] ABSTRACT: Unlabelled: The efficacy of DDAVP (1-deamino-8-D-arginine-vasopressin, desmopressin) in mild haemophilia A and von Willebrand disease (VWD) has been established and the use of this well tolerated drug has become clinical routine. In case of increased fluid intake and based on very rarely occurring hyponatraemia, the indication of administration of DDAVP intravenously (i. v.) has to be performed diligently in elderly patients and in children below the age of five years. Aim, patients: Due to clinical practice we were interested in finding prospective parameter potentially correlating with adverse reactions of DDAVP and initiated this study. From 2007 to 2008, we included 49 patients suspicious to suffer from mild haemophilia A (n = 1) or VWD (n = 48) and investigated efficacy and safety of DDAVP after intravenous administration (mean: 0.29±0.032 μg/kg body weight). They underwent clinical and laboratory investigation and were questioned with regard to potential adverse reactions immediately and three days after administration of DDAVP. Results, conclusion: Most adverse reactions were mild and no serious adverse drug reactions were either observed or reported by the subjects. We identified significant changes of heart rate, blood pressure and leucocytes after conduct of the DDAVP test. The value of these findings has to be investigated in later prospective randomized studies. Further research on identification of prospective parameter is currently ongoing.
    Article · Nov 2010 · Hamostaseologie
  • S Alesci · S Krekeler · W Miesbach
    Article · Nov 2010 · Haemophilia
  • W. Miesbach · S. Krekeler · S. Alesci
    Article · Jul 2010 · Haemophilia
  • S. Alesci · K. Bickhardt · S. Krekeler · [...] · W. Miesbach
    Article · Jan 2010
  • W Miesbach · S Krekeler · B Llugaliu · [...] · S Alesci
    Article · Oct 2009 · Hamostaseologie
  • W Miesbach · S Krekeler · S Alesci
    [Show abstract] [Hide abstract] ABSTRACT: Unlabelled: Treatment of elderly patients with haemophilia is an upcoming challenge in haemophilia care. We included patients with haemophilia A older than 60 years of age, who visited our haemophilia centre between 2006 and 2008. We conducted a retrospective study focussing on the patients' co-morbidities as well as changes in their bleeding patterns between 2003 and 2008. Results: There is a tendency of increasing bleeding symptoms with increasing age of the patients due to more frequent spontaneous joint bleedings, malignancies or treatment with phenprocoumon or ASS. In consequence, FVIII dosage had to be increased for 8 patients (28%). Chronic hepatitis C, coronary heart disease and malignancies are the most frequent co-morbidities.
    Article · Oct 2009 · Hamostaseologie
  • W Miesbach · S Alesci · S Krekeler · E Seifried
    [Show abstract] [Hide abstract] ABSTRACT: Variability of FVIII:C levels in healthy individuals and age-dependent increase are a known phenomenon. In haemophilia, increasing FVIII:C levels with age have not been described yet. In our study, we evaluated this issue retrospectively in a cohort older than 45 years of 29 patients with mild haemophilia and 14 patients with moderate or severe haemophilia at last visit at the haemophilia centre Frankfurt. The median duration of observation evaluated in this study was 17 years (range 5-28). Results show a significant correlation of increasing FVIII:C levels with age in mild haemophilia (P = 0.000041) and a non-significant tendency to a higher increase in higher age (P = 0.085652). The median difference of FVIII:C level between the first and last measurement was 8% of normal plasma concentration (range -3% to +35%). Median FVIII:C level increase of patients younger than 62 years was 7.5% (range -3 to 22), median increase in older patients was 12% (range 0-35). This tendency could not be correlated to decreased number of bleedings, but FVIII substitution dosage should be adapted to changing plasma levels at higher age to prevent overdosing or thrombotic risks. Possible causes and contributing factors for increasing FVIII:C levels are discussed. Statistical significance remains to be confirmed in larger prospective studies also including younger patients.
    Article · Jul 2009 · Haemophilia
  • W Miesbach · S Alesci · S Krekeler · E Seifried
    [Show abstract] [Hide abstract] ABSTRACT: The increasing numbers of comorbidities related to higher age and their treatment constitute a challenge in the treatment of haemophiliacs. Comparing prevalences of morbidities in the elderly haemophilia A population (n = 29) and the general elderly population of Germany reveals some differences. HCV infections are more frequent in the elderly haemophilia population (69% vs. 0.6%). Prevalence of cancer was five times higher than in the age matched general population (28% vs. 5.2%). Cardiac diseases seem to be less frequent although the prevalences of cardiovascular risk factors like hypertension, diabetes, and body mass index (BMI) >25 do not differ in comparison to the general population. A reduction of bleeding symptoms or dosage of FVIII could not be observed. There is a tendency of increasing bleeding symptoms with increasing age of the patients due to more frequent spontaneous joint bleedings, malignancies or treatment with phenprocoumon or ASA. In consequence, FVIII dosage had to be increased in eight patients (28%). Our patient population at the age >60 years is very small and no statistical evidence can be shown, therefore appropriate treatment of elderly haemophiliacs needs further evaluation in multicentre studies with sufficient patient numbers.
    Article · May 2009 · Haemophilia