Impact of sex, age, race, ethnicity and aspirin use on bleeding symptoms in healthy adults

Abstract

Coller BS. Impact of sex, age, race, ethnicity and aspirin use on bleeding symptoms in healthy adults. J Thromb Haemost 2011; 9: 100-8.Summary.Background: Comparing a patientÕs bleeding symptoms with those of healthy individuals is an important component of the diagnosis of bleeding disorders, but little is known about whether bleeding symptoms in healthy individuals vary by sex, race, ethnicity, age, or aspirin use. Objectives, Patients/Methods: We developed a comprehensive, ontologybacked, Web-based questionnaire to collect bleeding histories from 500 healthy adults. The mean age was 43 years (range 19-86 years), 63% were female, 19% were Hispanic, 37% were African-American, 43% were Caucasian, 8% were Asian, and 4% were multiracial. Results: 18 of the 36 symptoms captured occurred with < 5% frequency, and 26% of participants reported no bleeding symptoms (range 0-19 symptoms). Differences in sex, race, ethnicity, aspirin use and age accounted for only 6-13% of the variability in symptoms. Although men reported fewer symptoms than women (median 1 vs. 2, P < 0.01), there was no difference when sex-specific questions were excluded (median 1 for both men and women, P = 0.50). However, women reported more easy bruising (24% vs. 7%, P < 0.01) and venipuncture-related bruising (10% vs. 3%, P = 0.02). The number of symptoms did not vary by race or age, but epistaxis was reported more frequently by Caucasians than by African-Americans (29% vs. 18%, P = 0.02), and epistaxis frequency decreased with age (odds ratio 0.97 per year, P < 0.01). Paradoxically, infrequent aspirin users reported more bruising and heavy menses than frequent users (21% vs. 8%, P = 0.01, and 56% vs. 38%, P = 0.03, respectively). Conclusions: Our findings provide a contemporaneous and comprehensive description of bleeding symptoms in a diverse group of healthy individuals. Our Web-based system is freely available to other investigators.

Both Hemophilia Health Care Providers and Hemophilia A Carriers Report That Carriers Have Excessive Bleeding

“…Our survey as well as the previously reported data are not only consistent, but also emphasize the differences in bleeding tendencies reported when compared to a healthy population. In general, a healthy population of female adolescents and adults demonstrate menorrhagia in 35% (12), compared to the population of Hemophilia A carriers report that menorrhagia as defined by menstrual bleeding >7 days is present in over 50% in previously reported literature (2,3) and 94% in our current survey. This finding, along with other bleeding symptoms reported in our study and the two other concordant studies (2, 3), underscores the need for further investigation and education regarding Hemophilia A carriers.…”

Relationship between thromboelastography and long-term ischemic events as gauged by the response to clopidogrel in patients undergoing elective percutaneous coronary intervention

“…However, Gurbel et al reported that an MA ADP greater than 47 mm according to TEG significantly predicted long-term ischemic events in contrast to other measurements (9). Race is known to be an independent predictor of survival of coronary disease and individual differences in platelet reactivity are known to be heritable; several studies have found a lower frequency of epistaxis in Asians and African Americans than Caucasians (10,11).…”

Preoperative screening for bleeding disorders: A comprehensive laboratory assessment of clinical practice

“…First, like all bleeding questionnaires, the BAT is susceptible to the subjective interpretation of the severity of bleeding symptoms by both the patient and the professional administering the BAT 32. Second, healthy subjects are known to report bleeding symptoms 33, 34. Third, some hemostatic abnormalities present in our study population might not be expected to cause spontaneous bleeding symptoms (but may hinder operative hemostasis).…”