Recombinant FVIIa (NovoSeven) continuous infusion and total hip replacement in patients with haemophilia and high titre of inhibitors to FVIII: experience of two cases

Tagariello,; Biasi, De; Gajo,; Risato,; Radossi,; Davoli,; Traldi,

doi:10.1046/j.1365-2516.2000.00400.x

Cited by 31 publications

(28 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Issues related to the use of rFVIIa are the short halflife that requires frequent and repeated infusions particularly for surgery and the extremely high cost of a course of treatment. Continuous infusion of rFVIIa 16.5-50.0 lg kg h )1 [88][89][90][91][92][93][94][95][96], after administration of a bolus dose, has been shown to be effective with a 30% cost reduction [81,85,86], but no precise guidelines are available for its use by continuous infusion, a regimen that is not licensed at the moment.…”

Section: Treatment Of Bleeding and Prophylaxismentioning

confidence: 99%

Italian guidelines for the diagnosis and treatment of patients with haemophilia and inhibitors

Gringeri

Mannucci

2005

Haemophilia

View full text Add to dashboard Cite

The Italian Association of Haemophilia Centres reviewed and finally approved in November 2004 the new Italian Guidelines for the diagnosis and treatment of patients with clotting factor inhibitors. The recommendations have been based on the identification of levels of clinical evidence derived from the systematic review carried out in 2003 by the School of Health and Related Research, the University of Sheffield, UK, and further integrated by clinical studies published from 2003 to 2004. The Italian guidelines consist of six major domains concerning inhibitor definition, epidemiology, risk factors, diagnosis, inhibitor eradication, management of bleeding episodes, in patients with congenital and acquired coagulation disorders, with 121 statements, 59 synthesis and 54 recommendations. We report here recommendations and open issues concerning the diagnosis and monitoring of inhibitors, inhibitor eradication and the management of bleeding in patients with haemophilia A and B.

show abstract

Section: Treatment Of Bleeding and Prophylaxismentioning

confidence: 99%

Italian guidelines for the diagnosis and treatment of patients with haemophilia and inhibitors

Gringeri

Mannucci

2005

Haemophilia

View full text Add to dashboard Cite

show abstract

“…Although the same surgical procedures would be equally appropriate for patients with and without inhibitors, it was not until haematologists accumulated experience with haemostatically effective FVIII bypassing agents, namely activated prothrombin complex concentrates (APCCs) and recombinant activated factor FVII (rFVIIa), that it became feasible to consider performing ‘elective’ surgery in haemophilia patients with inhibitors. As Hedner’s pioneering report of a knee synovectomy on an inhibitor patient with the use of rFVIIa in 1988 [5], numerous single‐case reports and case series have reported good to excellent haemostatic results in patients undergoing a wide variety of major and minor surgical procedures, both orthopaedic and non‐orthopaedic [6–16].…”

Section: Resultsmentioning

confidence: 99%

Orthopaedic surgery in haemophilia patients with inhibitors: a practical guide to haemostatic, surgical and rehabilitative care

et al. 2009

View full text Add to dashboard Cite

All but essential surgery is generally avoided in haemophilia patients with inhibitor antibodies, because of concern about the reliability with which haemostasis can be achieved and maintained in such patients. Orthopaedic surgical procedures which are not required to preserve life fall under this category. As a result, patients with inhibitors may be denied operations, which could greatly enhance their quality of life, and which are routinely offered to other haemophilia patients. While caution is appropriate in recommending surgery in any circumstance, we believe that the threshold for offering validated surgical procedures to patients with inhibitors should be re-evaluated in the light of current surgical and rehabilitative techniques, and the long experience with safe and effective factor VIII inhibitor bypassing agents, namely activated prothrombin complex concentrates and recombinant activated factor FVII. In this article, we review the haematological, surgical and rehabilitative considerations relevant to orthopaedic surgery in haemophilia patients with inhibitors, and provide recommendations for carrying out such procedures.

show abstract

“…rFVIIa has been approved for the treatment of bleeding in haemophiliacs with inhibitors. Tagariello et al [30] have used rFVIIa during total hip replacement in two patients with haemophilia and high-titre inhibitors, and found that it to be effective. Therefore, the sites of activity are those in which it is needed, and the threat of DIC is considered to be minimal [7,29].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of NovoSeven^® during surgery on a haemophiliac with previous history of inhibitors

et al. 2003

View full text Add to dashboard Cite

Management of bleeding in haemophiliacs with a history of inhibitor remains problematic. With infusion of factor VIII (FVIII), development of an anamnestic response and possible appearance of high-titre inhibitor remains a valid concern. We report a case of a haemophiliac with a history of moderately high-titre FVIII inhibitor that had become undetectable. He had not received FVIII since 1997, when he became inhibitor negative. He had been managed during his bleeding episodes with prothrombin complex factor concentrates, which became less effective in controlling his bleeding. The patient had a history of recurrent, spontaneous shoulder joint dislocations with bleeding, pain and significant disability. Shoulder joint replacement surgery was suggested. Replacement therapy was discussed with the patient, who refused treatment with human FVIII because of his concern for possible anamnestic response and inhibitor rebound. Porcine FVIII was not acceptable due to his poor response when used once in the past, and his history of moderate allergic reaction. Therefore, recombinant factor VIIa (NovoSeven, Novo Nordisk, Princeton, NJ) was considered to be an acceptable option for the contemplated shoulder surgery. The patient underwent 2.5 h of surgery with NovoSeven infusion. The surgeons were impressed with the lack of bleeding in this traumatic surgery. Despite the continuously prolonged activated partial thromboplastin time and low FVIII levels, the patient maintained a remarkably dry surgical field. Effective haemostasis was achieved during and after this procedure. This case illustrates the usage of NovoSeven as an effective treatment modality in a haemophilia A patient with past history of inhibitor undergoing joint surgery.

show abstract

Recombinant FVIIa (NovoSeven) continuous infusion and total hip replacement in patients with haemophilia and high titre of inhibitors to FVIII: experience of two cases

Cited by 31 publications

References 7 publications

Italian guidelines for the diagnosis and treatment of patients with haemophilia and inhibitors

Italian guidelines for the diagnosis and treatment of patients with haemophilia and inhibitors

Orthopaedic surgery in haemophilia patients with inhibitors: a practical guide to haemostatic, surgical and rehabilitative care

Efficacy of NovoSeven^® during surgery on a haemophiliac with previous history of inhibitors

Contact Info

Product

Resources

About

Recombinant FVIIa (NovoSeven) continuous infusion and total hip replacement in patients with haemophilia and high titre of inhibitors to FVIII: experience of two cases

Cited by 31 publications

References 7 publications

Italian guidelines for the diagnosis and treatment of patients with haemophilia and inhibitors

Italian guidelines for the diagnosis and treatment of patients with haemophilia and inhibitors

Orthopaedic surgery in haemophilia patients with inhibitors: a practical guide to haemostatic, surgical and rehabilitative care

Efficacy of NovoSeven® during surgery on a haemophiliac with previous history of inhibitors

Contact Info

Product

Resources

About

Efficacy of NovoSeven^® during surgery on a haemophiliac with previous history of inhibitors