Apixaban and Eftrenonacog Alfa Treatment in a Patient with Moderate Hemophilia B and Cardiovascular Disease

Abstract

In developed countries, the life expectancy of patients with hemophilia (PwH) is now close to that of the unaffected male population. This means that these patients are at risk of developing age-related comorbidities, including cardiovascular disease. Managing cardiovascular disease in PwH patients can be particularly challenging, due to their high bleeding risk. To our knowledge, this is the first report of a male patient with moderate hemophilia B and hypertensive ischemic heart disease complicated by arrhythmia due to nonvalvular atrial fibrillation, who was treated with apixaban and left atrial appendage closure while receiving concomitant anti-hemorrhagic prophylaxis with eftrenonacog alfa.

Recombinant factor IX Fc for major surgery in hemophilia B: factor IX plasma activity levels and effective hemostasis

“…Extensive data from phase 3 pivotal and extension studies (B-LONG, Kids B-LONG, and B-YOND) have previously reported rFIXFc as effective and well-tolerated for the perioperative management of a wide range of surgeries in patients with hemophilia B (35 major surgeries in 22 subjects, 62 minor surgeries in 37 subjects) [ 3 , 4 ]. Real-world data also confirm the risk–benefit profile of rFIXFc and further supports its suitability for perioperative use [ [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] ].…”

“…Comparable hemostatic efficacy and safety with rFIXFc during the perioperative period have been demonstrated in real-world studies [ [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] ]. Particularly, a retrospective review of patients who underwent major surgeries in Ireland reported achieving effective hemostasis using rFIXFc with factor levels of 98 to 138 IU/dL ( n = 9) preoperatively, 58 to 109 IU/dL ( n = 6) postoperatively on D0, and 40 to 82 IU/dL on D1 to D3 (predose) [ 8 ].…”

Recombinant factor IX Fc for the treatment of hemophilia B

“…Multiple papers have described successful hemostatic responses with perioperative administration of rFIXFc for both major and minor procedures (Table 3) 62–66 and perioperative case studies have also been reported (Table S3). 67–70 …”