Full-length recombinant FVIII formulated with sucrose (rFVIII-FS; Kogenate Ò FS; KOGENATE Ò Bayer; KG-FS) is safe and efficacious when infused by bolus injection in patients with hemophilia A [1]. Administration of factor VIII (FVIII) by continuous infusion has certain advantages over intermittent bolus infusions or injections for prophylaxis against bleeding in the surgical setting and for prolonged therapy for severe bleeding episodes. Included in the advantages of continuous infusion are stability of plasma FVIII levels (elimination of plasma peaks and troughs), a reduction in overall quantity of FVIII required, and accordingly, potential cost benefits. A comprehensive review of continuous infusion was recently presented by Schulman [2]. This review compiled the data from a number of studies that compared bolus and continuous infusion therapies. A notable prospective study by Batarova and Martinowitz [3] compared the safety, efficacy, and factor requirements in 43 major surgical procedures performed in severe hemophilia patients with either bolus injections or continuous infusion. This study showed that continuous infusion of FVIII resulted in significantly higher nadir FVIII levels (P < 0.01), a significantly lower drop in hemoglobin levels (P < 0.05), significantly lower transfusion requirements (P < 0.01), and a significantly lower FVIII dosage (P < 0.01) compared with bolus injection.
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