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The aims of this study were to determine whether the current paradigm for prophylaxis requires a shift in focus from reducing the frequency of bleeding episodes to a goal of zero bleeding and to review and discuss the published data from <jats:italic>in vitro<\/jats:italic> and animal experiments and clinical studies in patients with haemophilia that describe the impact of joint bleeding. More than two to three bleeding into the same joint may cause irreversible and progressive structural damage that compromise health\u2010related quality of life (<jats:styled-content style=\"fixed-case\">HRQ<\/jats:styled-content>oL). A goal of zero bleeding episodes \u2013 or as close to zero as possible \u2013 is key to enhancing joint health and <jats:styled-content style=\"fixed-case\">HRQ<\/jats:styled-content>oL in children and adults with haemophilia. Achieving this goal requires individualized, outcome\u2010based, multidisciplinary care to maximize prophylactic efficacy without increasing overall health care costs.<\/jats:p>","DOI":"10.1111\/hae.12375","type":"journal-article","created":{"date-parts":[[2014,1,29]],"date-time":"2014-01-29T09:43:55Z","timestamp":1390988635000},"page":"459-463","source":"Crossref","is-referenced-by-count":94,"title":["The burden of bleeding in haemophilia: is one bleed too many?"],"prefix":"10.1111","volume":"20","author":[{"given":"A.","family":"Gringeri","sequence":"first","affiliation":[{"name":"Baxter Innovations GmbH Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Ewenstein","sequence":"additional","affiliation":[{"name":"Baxter Healthcare Corporation Westlake Village CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Reininger","sequence":"additional","affiliation":[{"name":"Baxter Innovations GmbH Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,1,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)13405-8"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2516.2012.02909.x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2010.03962.x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.2001.02580.x"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(96)70431-6"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2011.04611.x"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2008.03270.x"},{"key":"e_1_2_9_9_1","unstructured":"National Hemophilia Foundation.MASAC [Medical and Scientific Advisory Council] Recommendation 179. 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