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Author Notes:

Jonathan C. Roberts, Bleeding & Clotting Disorders Institute, 427W. Northmoor Rd., Peoria, IL 61614, USA. Email: jroberts@ilbcdi.org

SAH and AO conceived the analysis proposal, which was then discussed and refined with JCR, LMM and RFS. IH extracted and analysed the medical claims data. All authors were involved in data interpretation and determining the focus and content of the publication. All authors reviewed and commented on manuscript drafts and approved the final draft for publication.

Data were obtained from the IQVIA PharMetrics Plus database. Analyses were undertaken by Charles River Associates, Boston, MA, including Imrran Halari and was funded by Baxalta US Inc., a member of the Takeda group of companies, Lexington, MA, USA. Medical writing support was provided by Mary Berrington, PhD, and Iain Patefield, MS, of Parexel, Hackensack, NJ, USA, and was funded by Baxalta US Inc., a member of the Takeda group of companies, Lexington, MA, USA.

JCR has acted as a paid consultant for CSL Behring, Hema Biologics, Takeda, Sanofi Genzyme, Novo Nordisk, Octapharma, Pfizer, Spark and uniQure; is on speaker bureaus for Takeda, Sanofi Genzyme, Novo Nordisk and Octapharma; and has received funding for research from Takeda not related to this study. LMM has received research funding from Bioverativ and consulting fees from Takeda, Spark, Sanofi Genzyme, Bayer, Hema biologics and CSL. IH is a current employee of Charles River Associates. SAH is an employee of Baxalta US Inc., a Takeda company and holds stock and/or stock options in Takeda. AO was an employee of Baxalta US Inc., a Takeda company at the time of the study and owns Takeda stock. RFS has acted as a paid consultant to Takeda and Octapharma and has received an investigator‐initiated grant from Takeda for the ATHN 9 study (natural history study in severe VWD).


Research Funding:

This research was funded by Baxalta US Inc., a member of the Takeda group of companies, Lexington, MA, USA.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Hematology
  • database
  • diagnosis
  • epistaxis
  • gastrointestinal haemorrhage
  • menorrhagia
  • therapeutics
  • von Willebrand disease
  • 2A

Bleeding patterns in patients before and after diagnosis of von Willebrand disease: Analysis of a US medical claims database


Journal Title:



Volume 28, Number 1


, Pages 97-108

Type of Work:

Article | Final Publisher PDF


Introduction: Von Willebrand disease (VWD) is the most common inherited bleeding disorder. The bleeding phenotype is variable, and some individuals have persistent symptoms post-diagnosis. Aim: To characterize bleeding patterns in patients with VWD before and after diagnosis. Methods: De-identified claims data for commercially insured patients in the IQVIA PharMetrics® Plus US database (Jan-2006 to Jun-2015) were extracted. Eligible patients had ≥2 claims for VWD (ICD-9 code 286.4), and continuous health-plan enrolment for ≥2 years before and after diagnosis. Bleeding event, treatment and treating-physician type were analysed for 18 months before and 7-24 months after diagnosis, according to pre-diagnosis bleeding phenotype (claims from one vs multiple bleed sites) and post-diagnosis bleeding status (resolved [no post-diagnosis bleed claims] vs continued [≥1 claim]). Results: Data for 3756 eligible patients (72.6% female; 71.0% aged ≥18 years at diagnosis) were analysed. Overall, 642 (17.1%) and 805 (21.4%) patients had single- and multiple-site bleed claims pre-diagnosis, respectively, and 1263 (33.6%) patients (38.5% of women, 20.8% of men) continued to bleed post-diagnosis. Multiple-site bleeding was associated with pre-diagnosis heavy menstrual bleeding (HMB), oral contraceptive (OC) use and nasal cauterization. Continued bleeding post-diagnosis was associated with pre-diagnosis gastrointestinal bleeding, HMB and epistaxis; pre-diagnosis use of OCs, aminocaproic acid and nasal cauterization; and younger age at diagnosis. Few patients consulted a haematologist for bleed management. Conclusion: Many patients with VWD have persistent bleeding from multiple sites and continue to bleed post-diagnosis. Our findings suggest a need to optimize management to reduce the symptomatic burden of VWD following diagnosis.

Copyright information:

© 2021 The Authors. Haemophilia published by John Wiley & Sons Ltd.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/rdf).
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