老年和出血性疾病妇女

S. Radhakrishnan, R. d’Oiron
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摘要

随着预期寿命的增加,患有出血性疾病的女性在绝经后可能还能活几十年——可能伴有一系列合并症,包括心血管疾病、癌症和骨质疏松症。对于有出血性疾病(WBD)的女性来说,更年期前后的月经出血可能是严重的和不可预测的。激素替代疗法(HRT)仍然是那些衰弱的更年期症状和骨质疏松症预防的黄金标准。在无出血性疾病的普通人群中,内源性血管性血友病因子(VWF)水平随着年龄的增长而增加,并伴有因子VIII (FVIII)水平的升高。证据还表明血管性血友病(VWD)患者的VWF与年龄相关,轻度或中度a型血友病患者的FVIII增加的证据有限,但可能相关。然而,因子水平的年龄相关变化似乎与出血发作不完全相关,需要更多的数据来充分理解这一情况。综合护理的新模式需要考虑到出血性疾病女性和男性与年龄相关的合并症,包括多种药物的影响及其可能造成的不良反应和治疗依从性受损。还需要考虑手术、放疗和化疗等干预措施期间的出血覆盖,这些干预措施随着年龄的增长更有可能发生。随着人们对老年化对出血性疾病患者的影响有了更好的了解,治疗方案和护理途径也需要更新。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Ageing and women with bleeding disorders
Abstract As life expectancy increases, women with bleeding disorders can expect to live for decades after their menopause – potentially with a range of comorbidities including cardiovascular (CV) disease, cancer and osteoporosis. Menstrual bleeding around the menopause may be heavy and unpredictable for women with bleeding disorders (WBD). Hormone replacement therapy (HRT) remains the gold standard for those with debilitating menopausal symptoms and for osteoporosis prevention. Levels of endogenous von Willebrand factor (VWF) increase with age in the general population without bleeding disorders, with an associated rise in levels of Factor VIII (FVIII). Evidence also suggests age-related increases in VWF in people with von Willebrand disease (VWD), with limited but potentially associated evidence for increases in FVIII in those with mild or moderate haemophilia A. However, it appears that age-related changes in factor levels do not correlate completely with bleeding episodes, and more data are needed to fully understand the picture. New models of comprehensive care are needed that take account of age-related comorbidities in both women and men with bleeding disorders, including the impact of polypharmacy and its potential for causing adverse effects and impaired treatment adherence. Consideration will also be needed for bleeding cover during interventions such as surgery, radiotherapy and chemotherapy that become more likely with age. Protocols and care pathways need to be updated as the implications of ageing in women and men with bleeding disorders become better understood.
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