Prostate interventions in patients with mild haemophilia: Safe and feasible

Mesnard, B.; Drillaud, Nicolas; Sigaud, Marianne; Hakim, Gabriella; Chelly, Samuel; Ternisien, Catherine; Fouassier, Marc; Chelghaf, I.; Vergie, S. De; Verbe, M. Perrouin; Rigaud, J.; David, Arthur; Trossaërt, Marc; Branchereau, J.

doi:10.1111/hae.14388

Cited by 3 publications

(6 citation statements)

References 23 publications

(63 reference statements)

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“…The other two surgeries were a TURP and a laser vaporization, which are procedures described as causing increased bleeding, particularly when the scab falls off. 11 Again in these cases, tranexamic acid was not used, which would most likely limit this bleeding risk. Two of the cases of fair/poor efficacy seemed not to be related to the treatment or the hemophilia, since one bleed appeared while the FVIII level was normal (119 IU.dL À1 ) and the other was due to the removal of the gastrostomy tube by the patient himself.…”

Section: Discussionmentioning

confidence: 99%

“…Of these procedures, four were urological surgeries and tranexamic acid could not be used in two of those four procedures due to a contraindication related to coronary artery disease. The other two surgeries were a TURP and a laser vaporization, which are procedures described as causing increased bleeding, particularly when the scab falls off 11 . Again in these cases, tranexamic acid was not used, which would most likely limit this bleeding risk.…”

Section: Discussionmentioning

confidence: 99%

“…The demographic characteristics of the patients are detailed in Table 1. These procedures included hepatogastroenterological (21), stomatological (16), orthopedic (14), urological (13), dermatological (11), cardiovascular (6), ophthalmologic (3), and gynecological (2) surgeries. Five surgeries were performed in the context of cancer (two bladder carcinomas, two prostatic carcinomas, and one basal cell carcinoma).…”

Section: Patientsmentioning

confidence: 99%

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Efficacy and safety of turoctocog alfa in patients with hemophilia A requiring surgical procedures: A multicentre retrospective study

Drillaud,

Cussac,

Bertho

et al. 2023

Transfusion

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BackgroundTuroctocog alfa is a recombinant Factor VIII used in patients with hemophilia A. The aim is to assess the real‐life evidence of turoctocog alfa in surgery.Study Design and MethodsData were extracted from a national database.ResultsTuroctocog alfa was used for 86 surgeries (49 major and 37 minor) in 56 patients. The results are expressed as medians (interquartile range).Six (10.7%) patients had severe hemophilia A, four (7.1%) moderate, and 46 (82.2%) mild. For patients who underwent major surgeries, basal plasma FVIII coagulant activity (FVIII:C) levels were 15 IU.dL−1 (8–22). Eight (5–14) infusions were given, at a preoperative loading dose of 40.0 (35.0–45.5) IU.kg−1 and a total dose of 253.3 (125.0–507.0) IU.kg−1. In patients who underwent minor surgeries, basal FVIII:C levels were 18 IU.dL−1 (9–31). Two (1–3) infusions were required, at a preoperative loading dose of 34.0 (28.8–38.5) IU.kg−1 and a total dose of 73.7 (37.6–122.1) IU.kg−1. The overall clinical efficacy was judged excellent/good in 77 procedures (89.5%) and fair/poor in nine (10.5%). The fair/poor efficacy concerned seven patients (six mild hemophilia and one severe), for four urological surgeries, two dermatological procedures, one heart surgery, one ear‐nose‐throat procedure, and one dental avulsion in the patient with severe hemophilia. Three out of those seven patients received antiplatelet therapy. No thromboembolic events, anti‐FVIII antibodies, or adverse events were reported.DiscussionThe efficacy and safety of turoctocog alfa were confirmed for the management of surgery in patients with hemophilia A. No adverse events were observed and overall efficacy was good.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

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Efficacy and safety of turoctocog alfa in patients with hemophilia A requiring surgical procedures: A multicentre retrospective study

Drillaud,

Cussac,

Bertho

et al. 2023

Transfusion

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“…TURP is still regarded as the golden standard in the surgical treatment of BPH, but it is associated with higher complication rates compared to newer minimally invasive treatments (Rassweiler et al, 2006). In a recent study, TURP was associated with increased risk of bleeding in patients with HA, particularly after the patients have returned home (Mesnard et al, 2021). PAE is rapidly being established as a robust and safe alternative to surgery, especially in patients with larger prostates.…”

Section: Discussionmentioning

confidence: 99%

Prostatic artery embolization in men with severe hemophilia a: a case report of two patients

et al. 2022

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Background This is the first case report describing the peri- and postoperative hemostasis plans in two men with severe hemophilia A (HA) who underwent prostatic artery embolization (PAE) for symptomatic benign prostatic hyperplasia (BPH). Case presentation Two patients with severe HA and lower urinary tract symptoms (LUTS) not responding to medical therapy underwent PAE at our institution. In both patients, intermittent administration of decreasing doses of extended half-life recombinant factor VIII (EHL rFVIII) concentrate from 30 min before to 7 days after the PAE resulted in good hemostatic control. In addition to EHL rFVIII, tranexamic acid was administered in the same timeframe to augment the action of EHL rFVIII and to account for possible mucosal bleeding from the urinary tract. Both patients reported a minor localized hematoma at the femoral puncture site in the right groin, that resolved spontaneously. No other bleeding complications were observed. Conclusions The procoagulant effects of the chosen dosing of EHL rFVIII showed sufficient to perform a technically successful embolization. At 6 months follow-up, both patients had significant reduction in self-reported urinary symptoms and were content with the outcome.

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“…To date, there are no guidelines for the management of patients with bleeding disorders, particularly those undergoing urological surgery. Few studies have reported the results of focused surgical procedures, such as transurethral prostate or bladder resection [6], bladder and prostate biopsies, and prostatectomy [7]. None of the studies included all patients who received care in the urology surgery department, regardless of the surgical procedure.…”

Section: Introductionmentioning

confidence: 99%

Congenital Haemostasis Disorders and Urology Surgery: Is It Safe?

Bres,

Waeckel,

Repesse

et al. 2024

JCM

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Background: There are no specific recommendations for the management of patients with bleeding disorders (BD), such as haemophilia A (HA), haemophilia B (HB), or von Willebrand disease (WD), in urology surgery. Methods: We conducted a retrospective study of 32 patients with HA, HB, or WD of any severity. Fifty-seven procedures were performed between January 2017 and September 2023. Surgical interventions were divided into two groups: those with and without electrocoagulation. The control patients were successively matched in a 2:1 ratio. Results: The study group consisted of 30 men and 2 women, with 23 HA, 2 HB, and 7 WD. The median age of the patients was 69 years. The BD group had a longer hospital stay of 4 days compared to 1 day (p < 0.0001). The incidence of bleeding events was 21% versus 2% (p < 0.0001), and the incidence of complications was 21% versus 7% (p = 0.0036) for Clavien 1–2 respectively. In the subgroup with intraoperative coagulation, the readmission rate at 30 days was higher (17% vs. 3%, p = 0.00386), as was the transfusion rate (17% vs. 3%, p = 0.0386). Conclusions: This study showed that urological procedures in patients with bleeding disorders were associated with a higher risk of bleeding and complications.

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Prostate interventions in patients with mild haemophilia: Safe and feasible

Cited by 3 publications

References 23 publications

Efficacy and safety of turoctocog alfa in patients with hemophilia A requiring surgical procedures: A multicentre retrospective study

Efficacy and safety of turoctocog alfa in patients with hemophilia A requiring surgical procedures: A multicentre retrospective study

Prostatic artery embolization in men with severe hemophilia a: a case report of two patients

Congenital Haemostasis Disorders and Urology Surgery: Is It Safe?

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