Polypharmacy, defined as the use of 5 or more medications per day, has a high prevalence among patients with bleeding disorders such as hemophilia and von Willebrand disease (vWD), according to a recently published multicenter prospective observational study.

Polypharmacy is a frequent problem for individuals older than 65 years. Due to the success of replacement therapies for hemophilia and vWD, persons with these conditions now have a similar life expectancy to that of the general population. Therefore, many patients with hemophilia not only suffer from comorbidities associated with bleeding disorders but from those related to aging as well.

Due to the scarce literature covering the subject of polypharmacy among patients with bleeding disorders, the authors aimed to study the prevalence of both polypharmacy and medication regimen complexity in a population of 142 patients, 89 of them with hemophilia and 53 with vWD.


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Each patient’s sociodemographic and medical data were obtained through medical records, while medication data was obtained through a telephone interview with each patient.

The authors interrogated how many concomitant medications the patients used daily through the telephone interview. More than 5 medications a day qualified as polypharmacy and more than 10 medications a day qualified as excessive polypharmacy.

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Furthermore, the authors also assessed the medication regimen complexity through the Medication Regimen Complexity Index (MRCI), which consists of three sections, each focusing on dosage form, dosage frequency, and additional instructions for administration (such as those related to food), respectively.

The results showed that polypharmacy was prevalent in nearly 60% of patients, with over 15% taking more than 10 medications per day. The results showed no significant difference between hemophilia and vWD in this respect.

Regarding the medication regimen complexity, the mean MRCI in the studied population was 16.9, representing a high degree of medication regimen complexity. There was a higher tendency towards a high MRCI in patients with hemophilia, with a mean MRCI of 17.7 compared to 15.5 in patients with vWD.

A high MRCI has been associated with worse patient outcomes due to lower adherence to medication and a higher hospitalization rate.

“Faced with the medication regimen complexity, interventions focusing on medication review and deprescribing should be conducted and assessed to reduce polypharmacy with its negative health-related outcomes,” the authors concluded.

Reference

Novais T, Prudent C, Cransac A, et al. Polypharmacy and medication regimen complexity in older patients with hemophilia or von Willebrand disease: the M’HEMORRH-age study. Int J Clin Pharm. Published online June 15, 2022. doi:10.1007/s11096-022-01401-y