Investigators analyzed opioid exposure rates in adult and pediatric patients with hemophilia and reported their findings in Haemophilia.

Data were collected from hemophilia treatment centers (HTCs) at 2 institutions in Minnesota. These data were then compared with national opioid exposure data in patients with hemophilia, collected from the American Thrombosis and Hemostasis Network database (ATHNdataset), and in the general population, collected from the Centers for Disease Control and Prevention (CDC).

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Chronic pain medication use was defined as more than 3 consecutive months of prescribed or self-administered opioid or nonopioid medication use; less than 3 consecutive months of pain medication use was classified as acute pain medication use.

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In total, 183 adult patients and 135 pediatric patients with hemophilia were included in the analysis. Overall, the opioid exposure rate was 56% for adult patients, 21% for pediatric patients, and 6% for patients with hemophilia. Adult male patients and pediatric patients in this study also exhibited higher rates of opioid exposure compared with the exposure rates for the general age- and sex-matched populations reported by the CDC.

Chronic pain medication use was reported in 49% of adult patients, including 21% of patients who received chronic opioids. In patients who did not receive chronic opioids, 44% reported acute opioid use. Severe hemophilia was found to be a predictor of opioid exposure compared with nonsevere hemophilia (odds ratio, 3.14; 95% CI, 1.6-6.2; P <.001), with severe disease documented in 74% of patients receiving chronic opioids and 56% of patients receiving acute opioids.

Chronic pain medication use was reported in 10% of pediatric patients, though no patients received chronic opioids. However, 21% of patients received acute opioids. Severe hemophilia was reported in 64% of patients receiving chronic pain medication and 46% of patients receiving acute opioids; unlike the adult cohort, no association was found between hemophilia severity and opioid exposure in pediatric patients.

HTCs wrote the minority of acute opioid prescriptions for both adult (34%) and pediatric patients (23%).

The investigators noted that “opioid exposure in haemophilia patients appears to be grossly underreported in the ATHNdataset.” Furthermore, they suggested that HTCs should take “a more active role in periprocedural pain management, as suitable alternatives to opioids do exist.”


1.     Peltier SJ, Mazepa MA, Freeze RL, Nelson SF, Kearney SL, Reding MT. Opioid exposure in haemophilia patients is common and underreported [published online February 26, 2020]. Haemophilia. doi:10.1111/hae.13950