The aging hemophilia patient

Advances in the development of safe and effective treatments for hemophilia over the past century have significantly increased the life expectancy of persons with hemophilia (PwH). As a result, clinicians are now encountering age-related comorbidities that were previously uncommon in hemophilia care, including cardiovascular disease, malignancy, and renal disease. Managing this aging population of PwH requires addressing both the complications of hemophilia and the multifaceted effects of aging. Their care needs have become increasingly complex, requiring attention to broader aspects of health, such as liver and bone health, fall and fracture risk, and frailty. However, preventive care, including routine monitoring and treatment of these conditions, is a gap in the current care model for this population. Inadequate access to primary care physicians negatively impacts the management and prevention of chronic diseases in PwH, resulting in medical vulnerability. The focus of this review is to examine prevalent complications in the aging PwH. Case studies presented focus on identifying and reducing cardiovascular disease risk, weighing bleeding risk with stroke risk in the management of atrial fibrillation, and ensuring a multidisciplinary approach to address frailty, bone health, and orthopedic surgery in the aging PwH. As we enter a new era of therapeutics, hemophilia treatment centers will play an integral role in closing care gaps in helping PwH achieve optimal outcomes.