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St. Thomas’ Hospital’s renowned Haemophilia Centre publishes new findings on use of cold therapy
Reduced pain and swelling but no adverse effects with CryoCuff™ treatment of haemarthroses in severe haemophilia.

The latest research published in the May issue of Haemophilia, (Online Early) by one of the World’s leading Haemophilia treatment and research centres, contains some reassuring findings for users of the PRICE (Protection, Rest, Ice, Compression and Elevation) regime who recommend the CryoCuff™ as part of the immediate factor replacement therapy protocol for acute management of haemophilic bleeding episodes in the home.
The research, conducted by Ian d’Young at the Centre for Haemostasis and Thrombosis at the Haemophilia Reference Centre at London’s St Thomas Hospital, set out to investigate the safety and usefulness of the CryoCuff™ device in the management of acute haemarthroses in the home setting.

Integral to this regime is the application of cold therapy but little is known regarding the safe periods of application, or indeed the relative safety of a cryotherapy device, such as the CryoCuffTM, when used by patients at home. This is especially important when speeding up the resolution of haemarthrosis to reduce blood-induced joint-damage. The research also set out to consider whether the application protocol for using the CryoCuff™ is reasonable and achievable for patients with severe forms of haemophilic bleeding disorders.

Twelve patients, either with severe haemophilia A/B or with VWD (von Willebrand’s disease), were recruited and asked to use the CryoCuff™ device as part of the PRICE regime immediately following bleeds from either knee, ankle or elbow for short 15 minute applications repeated every 1-2 hours for a year. At the end of the year, each subject completed a qualitative questionnaire to determine the perceived benefit or any adverse reactions to the device.

Results showed that all patients not only found the application protocol easy to follow and were able to tolerate it for the recommended time, but also felt the CryoCuff™ had a significant impact on alleviating pain and a return to pre-bleed status. In addition, 78% felt it led to significant reductions in swelling around the affected joint. There was, however, no conclusive evidence that the CryoCuff™ resulted in any reduction in the amount of factor used to treat the acute bleeding episode, but then no patients reported any perceived delay in achieving haemostasis or required extra factor replacement therapy.

Interestingly, the researchers also noted that, theoretically, the reduced pain and swelling around the joints when cold therapy is applied (from the earliest onset of bleeding or injury) may lead to reduced exposure of the surrounding soft tissues or articular surfaces to blood by its vasoconstrictive effect. It is thought that this in turn may speed up the resolution of haemarthrosis, or may reduce the overall exposure of the articular surfaces, thereby reducing blood - induced joint damage.

In conclusion it was felt the results showed the CryoCuff™ to be a safe device for the application of cold therapy to haemarthrosis affecting hinge joints such as the knees, ankles or elbows. Although there is no evidence to suggest the CryoCuff™ allows for reduced factor therapy in response to haemarthrosis, it can significantly reduce perceived pain (associated with joint bleeding) and there is a strong indication that joint swelling and the return to pre-bleed status are improved.

Research published Haemophilia “OnlineEarly” article doi: 10.1111/j.1365-2516.2008.01701.x by A.I.d’Young

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