A Successful Coronary Artery Bypass Operation with Intermittent Factor VIII Administration in a Hemophilia A Patient Who Was Admitted Due to Acute Myocardial Infarction: A Rare and Difficult Case

Cardiac Surgery in Patients With Blood Disorders

“…Desired cardiac surgery factor levels, including the use of cardiopulmonary bypass (CPB), are not specified by the WHF. The studies' target levels were set at a factor level more than 80% of normal, reported using the activated partial thromboplastin time (aPTT) [19][20][21][22][23] or aPTT in combination with the more recent TEG R-time [24][25][26], to confirm effectiveness of factor replacement. The targets were achieved using bolus doses, most studies reported either use of recombinant (rFVIII/rFIX) or plasma derived (pdFVIII/ pdFIX) factor concentrate [19,20,22,24,25]; the WHF does not state a preference between the two [18].…”

“…Haemophilia A and B. The early postoperative factor level was aimed to be maintained above 80% through bolus [20,23,25] or continuous [19][20][21]24,26] infusions of factor replacement. Continuous infusion, adjusted daily to account for clearance, improves safety as steady-state concentration avoids peaks associated with thrombotic risk, and troughs associated with bleeding risk [53].…”