Surgery in Inhibitor Patients

Concomitant use of bypassing agents with emicizumab for people with haemophilia A and inhibitors undergoing surgery

“… 5 , 6 For people with haemophilia and FVIII inhibitors, bypassing agents (BPAs)—including activated prothrombin complex concentrates (aPCC) and activated recombinant factor VII (rFVIIa)—and antifibrinolytic agents may be used during surgical procedures to maintain haemostasis. 6 , 7 The choice of BPA to manage bleeding episodes may be influenced by access, safety, patient age and historical haemostatic response to treatment. 7 Both aPCC and rFVIIa have demonstrated haemostatic efficacy for the treatment of patients with inhibitors who are undergoing surgery.…”

“… 6 , 7 The choice of BPA to manage bleeding episodes may be influenced by access, safety, patient age and historical haemostatic response to treatment. 7 Both aPCC and rFVIIa have demonstrated haemostatic efficacy for the treatment of patients with inhibitors who are undergoing surgery. 7 However, there is a lack of standardised laboratory assays that have been demonstrated to effectively monitor haemostatic response to BPAs, and protocols for the dose and administration of BPAs vary between procedures and treatment centres.…”

“… 7 However, there is a lack of standardised laboratory assays that have been demonstrated to effectively monitor haemostatic response to BPAs, and protocols for the dose and administration of BPAs vary between procedures and treatment centres. 7 …”

“…The development of inhibitory antibodies to factor VIII (FVIII) is the most significant complication of haemophilia treatment and can result in increased morbidity, bleeding risk, joint damage and indication for surgical intervention 5,6 . For people with haemophilia and FVIII inhibitors, bypassing agents (BPAs)—including activated prothrombin complex concentrates (aPCC) and activated recombinant factor VII (rFVIIa)—and antifibrinolytic agents may be used during surgical procedures to maintain haemostasis 6,7 . The choice of BPA to manage bleeding episodes may be influenced by access, safety, patient age and historical haemostatic response to treatment 7 .…”

“…5,6 For people with haemophilia and FVIII inhibitors, bypassing agents (BPAs)-including activated prothrombin complex concentrates (aPCC) and activated recombinant factor VII (rFVIIa)-and antifibrinolytic agents may be used during surgical procedures to maintain haemostasis. 6,7 The choice of BPA…”