The CHI-MA-HAEM-NET project created a collaboration between the Department of Pathology at the University of Malta, led by Prof. Alexander Gatt and the Soochow University, China, led by .
Haemophilia is a rare bleeding disorder resulting from a deficiency of coagulation factor VIII (haemophilia A) or coagulation factor IX (haemophilia B). Patients with haemophilia tend to develop spontaneous bleeding especially into joints (haemophilic arthropathy), which may require surgery (such as knee arthroplasty). Joint replacement surgery are common procedures carried out in several people worldwide secondary mainly to osteoarthritis. In similar cases, there is a very high risk of the life-threatening complication of venous thrombosis. This dictates that chemical thromboprophylactic measures, such as heparins and oral anticoagulants, are normally used for prevention. Due to their intrinsic bleeding tendency, it is currently debated whether haemophilia patients should receive any type of anticoagulant thromboprophylaxis, in order to prevent deep vein thrombosis or pulmonary embolism.
This was an aspect studied within the CHI-MA-HAEM-NET project using a two-pronged approach. In Malta we devised an in vitro model of haemophilia in order to evaluate the effect of prophylactic concentrations of different anticoagulants on haemophilia A (factor VIII deficient plasma) and haemophilia B (factor IX deficient plasma), whereas in China, we looked at the actual risk of thrombosis in haemophilia patients who had undergone joint replacement surgery. The latter were treated with Factor VIII or Factor IX concentrates to normalise their factor deficiency, but they were not treated with routine prophylactic anticoagulation. The latter study published in , showed that there is no increased risk of thrombosis in this patient group when treated with a specific protocol. Locally, using a novel global assay of coagulation, our results show that treatment can be personalised in similar patients and that in agreement with what we demonstrated in the Chinese cohort, universal prophylactic anticoagulation is not necessary to dampen coagulation further.
These important observations are crucial for the refinement of disease specific guidelines and for the management of patients with similar bleeding disorders. This was only made possible by the collaboration of two countries and the funding from (previously Malta Council for Science and Technology (MCST)) and the Ministry for Science and Technology of the People鈥檚 Republic of China (MOST), through the Sino-Malta Fund 2021 (Science and Technology Cooperation).
