Experience of four UK comprehensive care centres using FEIBA® for surgeries in patients with inhibitors

Haemophilia : the Official Journal of the World Federation of Hemophilia
S RangarajanJ Wilde

Abstract

Increasing evidence indicates that factor VIII (FVIII) inhibitor bypassing agents (FEIBA® and NovoSeven®) can provide effective peri-operative haemostasis in haemophilia patients with high-responding inhibitors. We report the collected experience of all major and minor surgeries, conducted between December 1998 and September 2008, at four UK haemophilia Comprehensive Care Centres with FEIBA® as the first-line bypassing agent in patients with inhibitors. A total of 26 surgical procedures were performed in 18 patients of ages 34-83 years including five patients with acquired FVIII inhibitors. A single pre-operative infusion of FEIBA was followed by 6-12 h interval dosing for major surgeries at the discretion of the physician to approximate a maximum of 200 U kg(-1) day(-1), with tapering when postoperative haemostasis and wound healing permitted. Haemostatic outcomes were retrospectively reviewed against European consensus thresholds for blood loss and duration of treatment compared with expectations for equivalent procedures in non-inhibitor patients. Peri-operative haemostatic outcome with FEIBA was rated excellent or good in 78% of 18 major surgeries in 12 patients, including 11 major orthopaedic procedures. Haemostatic outcom...Continue Reading

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