Spanish consensus guidelines on prophylaxis with bypassing agents for surgery in patients with haemophilia and inhibitors

Introduction Patients with severe haemophilia and inhibitors against factor VIII who require surgery need a prophylactic approach to prevent bleeding complications. Scientific evidence to decide the best prophylactic treatment is very limited and mainly based on retrospective or case series. Aims To...

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Bibliographic Details
Published in:European journal of haematology 2016-05, Vol.96 (5), p.461-474
Main Authors: Mingot-Castellano, María Eva, Álvarez-Román, María Teresa, López-Fernández, María Fernanda, Altisent-Roca, Carmen, Canaro-Hirnyk, Mariana Isabel, Jiménez-Yuste, Víctor, Cid-Haro, Ana Rosa, Pérez-Garrido, Rosario, Sedano-Balbas, Carmen
Format: Article
Language:English
Subjects:
Age Factors
consensus
Disease Management
Factor VIIa - administration & dosage
Factor VIIa - adverse effects
Factor VIIa - drug effects
Factor VIII - adverse effects
Factor VIII - immunology
Factor VIII - therapeutic use
Hemophilia A - complications
Hemophilia A - drug therapy
Hemophilia A - immunology
Hemorrhage - diagnosis
Hemorrhage - etiology
Hemorrhage - prevention & control
Hemorrhage - surgery
Humans
inhibitors
Isoantibodies - immunology
Orthopedic Procedures
Practice Guidelines as Topic
Premedication
prophylaxis
Recombinant Proteins - administration & dosage
Recombinant Proteins - adverse effects
Recombinant Proteins - drug effects
Retreatment
surgery haemophilia
Surgical Procedures, Operative - methods
Time-to-Treatment
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Summary:Introduction Patients with severe haemophilia and inhibitors against factor VIII who require surgery need a prophylactic approach to prevent bleeding complications. Scientific evidence to decide the best prophylactic treatment is very limited and mainly based on retrospective or case series. Aims To develop evidence‐ and expert opinion‐based guidelines for prophylactic therapy for patients with haemophilia and inhibitors undergoing surgery. Methods A panel of nine Spanish haematologists undertook a systematic review of the literature and selected publications providing relevant information regarding the prophylactic management of patients with haemophilia and inhibitors undergoing dental extraction, minor surgery or major surgery. Results Although evidence is very limited, the panel considers that it seems advisable that prophylaxis should be given in most cases with a bypassing agent (aPCC or rFVIIa) and should start immediately before minor or major surgery. Patients should be closely monitored to enable dose/product modification as needed. Conclusion It is necessary to communicate clinical experience in a detailed way in order to ensure optimal schemes of prophylaxis for patients with haemophilia and inhibitors. Development of objective outcomes to evaluate efficacy is crucial.
ISSN:0902-4441
1600-0609
DOI:10.1111/ejh.12730