Management of major surgery in patients with haemophilia A using continuous infusion vs. bolus injections of FVIII – a pharmacokinetic approach to treatment
Authors:
D. Jankovičová 1; B. Šteňo 2; T. Prigancová 1; A. Morongová 1; J. Škultéty 3; I. Majeský 3; E. Khúnová 1; M. Mistrík 1; A. Bátorová 1
Authors‘ workplace:
Klinika hematológie a transfuziológie LF UK, SZU, Univerzitná nemocnica Bratislava
1; II. Ortopedicko-traumatologická klinika LF UK, Univerzitná nemocnica Bratislava
2; II. Chirurgická klinika LFUK, Univerzitná nemocnica Bratislava
3
Published in:
Transfuze Hematol. dnes,23, 2017, No. 2, p. 61-72.
Category:
Comprehensive Reports, Original Papers, Case Reports
Overview
Management of major surgery represents the most challenging issue of replacement therapy in severe haemophilia. The aim of our open, prospective, nonrandomised study was to evaluate continuous infusion (CI) of factor VIII (FVIII) and traditional therapy with bolus injections (BI) in severe haemophilia A patients undergoing major surgery with similar requirements regarding intensity and duration of replacement therapy, namely 13 days. We also focused on the benefit of preoperative pharmacokinetics (PK) studies either for CI or BI therapy. We evaluated a total of 100 major surgeries performed between 1998 and 2016 in 60 patients without inhibitors. Of these, 49 and 51 surgeries were performed using CI and BI respectively. Median trough levels of FVIII were comparable in both CI and BI groups [68% (interquartile range 59–90%) vs. 70% (57–77%)]. However, in the CI group we observed a lower, though non-significant, level of blood loss; fall in haemoglobin and number of serious bleedings compared with the BI group. In the CI group, there was a significantly lower number of patients requiring blood transfusions (33% vs. 55%, p < 0.05). Gradual decrease of FVIII clearance during CI resulted in lower week 1 and total FVIII consumption [357 (308–378) IU/kg vs. 426 (375–467) IU/kg and 520 (474–585) IU/kg vs. 612 (554–625) IU/kg, respectively, p < 0.001], especially due to significant FVIII cost reduction in patients with total arthroplasty treated with CI. PK evaluation performed before 60 surgeries (44 CI and 16 BI) revealed a shorter biological half time < 10 h in 17 (28%) patients tested, suggesting the potential of PK for individual tailoring of effective postoperative factor replacement either using CI or BI with the aim of further increasing the safety of major surgical procedures in haemophilia.
Key words:
haemophilia – major surgery – continuous infusion – bolus injections – pharmacokinetics of FVIII
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