Premium
Major surgery in severe haemophilia A with inhibitors using a recombinant factor VII a and activated prothrombin complex concentrate hybrid regimen
Author(s) -
Veen J. J.,
Maclean R. M.,
Hampton K. K.,
Hamer A.,
Makris M.
Publication year - 2014
Publication title -
haemophilia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.213
H-Index - 92
eISSN - 1365-2516
pISSN - 1351-8216
DOI - 10.1111/hae.12365
Subject(s) - medicine , dosing , tranexamic acid , regimen , haemophilia , prothrombin complex , prothrombin complex concentrate , surgery , haemophilia a , emergency surgery , anesthesia , coagulation , warfarin , blood loss , atrial fibrillation
Summary Major surgery in persons with haemophilia A and inhibitors is increasingly being performed. Both recombinant activated factor VII ( rFVII a) and activated prothrombin complex concentrate ( APCC ) are used to cover surgery but it remains unclear what the optimal dosing schedules are. We describe the use of a hybrid regimen in four inhibitor patients undergoing eight major surgical procedures using rFVII a in the initial 2–6 postoperative days followed by FEIBA ® for the remaining period. All patients were also treated with tranexamic acid while receiving rFVII a. We performed six major orthopaedic procedures, one emergency orchidectomy and one open appendectomy. The dosing schedules were at the higher end of those described in the literature but within the recommendations of the summary of product characteristics. Despite this, we encountered non‐surgical bleeding in four of eight episodes. Three of these occurred in one individual suggesting a patient factor. The overall outcome was good for all episodes. The hybrid regimen combines flexibility of dose and dosing frequency of rFVII a in the immediate postoperative setting with the advantage of a reduced dosing frequency with FEIBA ® in the subsequent days. This study also emphasizes that surgical procedures in this patient group remain a challenge.