Document Detail

Major surgery in haemophilic patients with inhibitors using recombinant factor VIIa.
MedLine Citation:
PMID:  8904185     Owner:  NLM     Status:  MEDLINE    
In the haemophilic patient, development of antibodies that inhibit the function of the missing coagulation factor causes several delicate problems. Most importantly, antibodies will block the function of the specific coagulation factor, and often the antibody activity is so fierce that effective substitution therapy is outruled. In consequence, alternative measures must be adopted to control bleeding. Amongst those most commonly employed, like factor IX concentrates, activated prothrombin complex concentrates, and factor VIII of porcine origin, a new recombinant activated factor VII molecule has been evaluated clinically for some years with promising results. The aim of the present paper was to present a series of patients suffering from haemophilia A or B in whom inhibitors have complicated the clinical picture, and in whom a surgical procedure was indicated. As part of a compassionate use program devised by the producer of this genetically engineered factor VIIa, 12 patients underwent life-saving or essential surgery where the recombinant factor VIIa product was used to promote haemostasis in 13 surgical procedures. Due to a short in vivo half-life of activated factor VIIa, frequent administration was scheduled, injecting factor VIIa every 2-3 h for up to 2 days after which dosage intervals were prolonged. In one case, a global evaluation of the end treatment result was not reported, but in all of the other 12 cases the end result were considered excellent (n = 11) or efficient (n = 1). In none of the cases was other types of coagulation factor treatment modalities necessary. In conclusion, recombinant factor VIIa seems a tempting alternative to traditional treatment of the haemophilic patient with inhibitors, in whom surgery is called for. With other types of haemostatic agents, surgery in haemophilic inhibitor patients has only been studied rarely, and operations have generally been restricted to life-threatening situations.
J Ingerslev; D Freidman; D Gastineau; G Gilchrist; H Johnsson; G Lucas; J McPherson; E Preston; E Scheibel; M Shuman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Haemostasis     Volume:  26 Suppl 1     ISSN:  0301-0147     ISO Abbreviation:  Haemostasis     Publication Date:  1996  
Date Detail:
Created Date:  1997-02-19     Completed Date:  1997-02-19     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0371574     Medline TA:  Haemostasis     Country:  SWITZERLAND    
Other Details:
Languages:  eng     Pagination:  118-23     Citation Subset:  IM    
Coagulation Laboratory and Haemophilia Centre, University Hospital Aarhus/Skejby, Denmark.
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MeSH Terms
Antibody Formation
Factor VIIa / therapeutic use*
Hemophilia A / drug therapy*,  immunology
Monitoring, Physiologic
Postoperative Complications / prevention & control*
Recombinant Proteins / therapeutic use
Reg. No./Substance:
0/Recombinant Proteins; EC VIIa

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