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Windyga J, Timofeeva M, Stasyshyn O, Mamonov V, Lamas Castellanos JL, Lissitchkov T, Chojnowski K, Chapman M, Pavlova BG, Tangada S. Phase 3 Clinical Trial: Perioperative Use of Nonacog Gamma, a Recombinant Factor IX, in Previously Treated Patients With Moderate/Severe Hemophilia B. Clin Appl Thromb Hemost 2021; 26:1076029620946839. [PMID: 32816519 PMCID: PMC7444148 DOI: 10.1177/1076029620946839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hemostatic management is essential for ensuring the safety of patients with hemophilia during surgery. This phase 3, prospective, uncontrolled trial, evaluated hemostatic efficacy, consumption, and safety of a recombinant factor IX concentrate, nonacog gamma (BAX 326, Rixubis® [Baxalta US Inc., a Takeda company, Lexington, MA, USA]), in intraoperative and postoperative settings in previously treated patients (PTPs) with severe or moderately severe hemophilia B undergoing elective surgery (N = 38 surgeries; 21 major, 17 minor). Predefined preoperative hemostatic factor IX levels (80-100% of normal for major and 30-60% for minor surgeries) were maintained for each patient. Intraoperative efficacy was rated as “excellent” or “good” for all surgeries. Postoperative hemostatic efficacy on day of discharge was rated as “excellent,” “good,” and “fair,” respectively, for 29 (76.3%), 7 (18.4%), and 2 (5.3%) surgical procedures. All adverse events were considered unrelated to study drug; most frequently reported was mild procedural pain (9 patients). No thrombotic events, severe allergic reactions, or inhibitor formation were observed. Nonacog gamma was well tolerated and effective for intraoperative and postoperative hemostatic management of PTPs with hemophilia B. NCT01507896, EudraCT: 2011-000413-39
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Affiliation(s)
- Jerzy Windyga
- Department of Hemostatic Disorders and Internal Medicine, Laboratory of Hemostasis and Metabolic Diseases, 49564Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Margarita Timofeeva
- Federal State Budgetary Institution of Science "Kirov Scientific and Research Institute of Hematology and Blood Transfusion of Federal Medico-Biological Agency," Kirov, Russia
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Strategies for Individualized Dosing of Clotting Factor Concentrates and Desmopressin in Hemophilia A and B. Ther Drug Monit 2019; 41:192-212. [DOI: 10.1097/ftd.0000000000000625] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Hazendonk HCAM, Preijers T, Liesner R, Chowdary P, Hart D, Keeling D, Driessens MHE, Laros-van Gorkom BAP, van der Meer FJM, Meijer K, Fijnvandraat K, Leebeek FWG, Mathôt RAA, Collins PW, Cnossen MH. Perioperative replacement therapy in haemophilia B: An appeal to "B" more precise. Haemophilia 2018; 24:611-618. [PMID: 29707861 DOI: 10.1111/hae.13469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Haemophilia B is caused by a deficiency of coagulation factor IX (FIX) and characterized by bleeding in muscles and joints. In the perioperative setting, patients are treated with FIX replacement therapy to secure haemostasis. Targeting of specified FIX levels is challenging and requires frequent monitoring and adjustment of therapy. AIM To evaluate perioperative management in haemophilia B, including monitoring of FIX infusions and observed FIX levels, whereby predictors of low and high FIX levels were assessed. METHODS In this international multicentre study, haemophilia B patients with FIX < 0.05 IU mL-1 undergoing elective, minor or major surgical procedures between 2000 and 2015 were included. Data were collected on patient, surgical and treatment characteristics. Observed FIX levels were compared to target levels as recommended by guidelines. RESULTS A total of 255 surgical procedures were performed in 118 patients (median age 40 years, median body weight 79 kg). Sixty percent of FIX levels within 24 hours of surgery were below target with a median difference of 0.22 IU mL-1 [IQR 0.12-0.36]; while >6 days after surgery, 59% of FIX levels were above target with a median difference of 0.19 IU mL-1 [IQR 0.10-0.39]. Clinically relevant bleeding complications (necessity of a second surgical intervention or red blood cell transfusion) occurred in 7 procedures (2.7%). CONCLUSION This study demonstrates that targeting of FIX levels in the perioperative setting is complex and suboptimal, but although this bleeding is minimal. Alternative dosing strategies taking patient and surgical characteristics as well as pharmacokinetic principles into account may help to optimize and individualize treatment.
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Affiliation(s)
- H C A M Hazendonk
- Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - T Preijers
- Hospital Pharmacy - Clinical Pharmacology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - R Liesner
- Great Ormond Street Haemophilia Centre, Great Ormond Street Hospital for Children NHS trust, London, UK
| | - P Chowdary
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Royal Free London NHS Foundation Trust, London, UK
| | - D Hart
- Department of Haematology, The Royal London Hospital Barts Health NHS Trust, London, UK
| | - D Keeling
- Oxford Haemophilia and Thrombosis Centre, Oxford University Hospitals, Churchill Hospital, Oxford, UK
| | - M H E Driessens
- Netherlands Haemophilia Patient Society (NVHP), Nijkerk, The Netherlands
| | | | - F J M van der Meer
- Department of Thrombosis and Haemostasis, Leiden University Medical Centre, Leiden, The Netherlands
| | - K Meijer
- Department of Haematology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - K Fijnvandraat
- Department of Paediatric Haematology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - F W G Leebeek
- Department of Haematology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - R A A Mathôt
- Hospital Pharmacy - Clinical Pharmacology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - P W Collins
- Arthur Bloom Haemophilia Centre, Institute of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - M H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Centre - Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
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Hazendonk HCAM, van Moort I, Mathôt RAA, Fijnvandraat K, Leebeek FWG, Collins PW, Cnossen MH. Setting the stage for individualized therapy in hemophilia: What role can pharmacokinetics play? Blood Rev 2018; 32:265-271. [PMID: 29426727 DOI: 10.1016/j.blre.2018.01.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/16/2018] [Accepted: 01/23/2018] [Indexed: 02/06/2023]
Abstract
Replacement therapy with clotting factor concentrates (CFC) is the mainstay of treatment in hemophilia. Its widespread application has led to a dramatic decrease in morbidity and mortality in patients, with concomitant improvement of quality of life. However, dosing is challenging and costs are high. This review discusses benefits and limitations of pharmacokinetic (PK)-guided dosing of replacement therapy as an alternative for current dosing regimens. Dosing of CFC is now primarily based on body weight and based on its in vivo recovery (IVR). Benefits of PK-guided dosing include individualization of treatment with better targeting, more flexible blood sampling, increased insight into association of coagulation factor levels and bleeding, and potential overall lowering of overall costs. Limitations include a slight burden for the patient, and availability of closely collaborating, experienced clinical pharmacologists.
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Affiliation(s)
- H C A M Hazendonk
- Department of Pediatric Hematology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - I van Moort
- Department of Pediatric Hematology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - R A A Mathôt
- Hospital Pharmacy - Clinical Pharmacology, Academic Medical Center, Amsterdam, The Netherlands
| | - K Fijnvandraat
- Department of Pediatric Hematology, Academic Medical Center, Amsterdam, The Netherlands; Department of Plasma Proteins, Sanquin Research, Amsterdam, The Netherlands
| | - F W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - P W Collins
- Department of Haematology, School of Medicine, Cardiff University, United Kingdom
| | - M H Cnossen
- Department of Pediatric Hematology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands.
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Neufeld EJ, Solimeno L, Quon D, Walsh C, Seremetis S, Cooper D, Iyer NN, Hoxer CS, Giangrande P. Perioperative management of haemophilia B: A critical appraisal of the evidence and current practices. Haemophilia 2017; 23:821-831. [PMID: 28752639 DOI: 10.1111/hae.13279] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2017] [Indexed: 01/19/2023]
Affiliation(s)
| | - L. Solimeno
- IRCCS Cà Granda Foundation; Maggiore Hospital; Milan Italy
| | - D. Quon
- Orthopaedic Hemophilia Treatment Center; Los Angeles USA
| | - C. Walsh
- Mount Sinai Hospital; New York USA
| | | | | | | | | | - P. Giangrande
- Oxford University Hospitals NHS Trust; Oxford Haemophilia Centre; Oxford UK
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Abstract
Hemophilia B is an X-linked genetic deficiency of coagulation factor IX (FIX) activity associated with recurrent deep tissue and joint bleeding that may lead to long-term disability. FIX replacement therapy using plasma-derived protein or recombinant protein has significantly reduced bleeding and disability from hemophilia B, particularly when used in a prophylactic fashion. Although modern factor replacement has excellent efficacy and safety, barriers to the broader use of prophylaxis remain, including the need for intravenous (IV) access, frequent dosing, variability in individual pharmacokinetics, and cost. To overcome the requirement for frequent factor dosing, novel forms of recombinant FIX have been developed that possess extended terminal half-lives. Two of these products (FIXFc and rIX-FP) represent fusion proteins with the immunoglobulin G1 (IgG1) Fc domain and albumin, respectively, resulting in proteins that are recycled in vivo by the neonatal Fc receptor. The third product has undergone site-specific PEGylation on the activation peptide of FIX, similarly resulting in a long-lived FIX form. Clinical trials in previously treated hemophilia B patients have demonstrated excellent efficacy and confirmed less-frequent dosing requirements for the extended half-life forms. However, gaps in knowledge remain with regard to the risk of inhibitor formation and allergic reactions in previously untreated patient populations, safety in elderly patients with hemophilia, effects on in vivo FIX distribution, and cost-effectiveness. Additional strategies designed to rebalance hemostasis in hemophilia patients include monoclonal-antibody-mediated inhibition of tissue factor pathway inhibitor activity and siRNA-mediated reduction in antithrombin expression by the liver. Both of these approaches are long acting and potentially involve subcutaneous administration of the drug. In this review, we will discuss the biology of FIX, the evolution of FIX replacement therapy, the emerging FIX products possessing extended half-lives, and novel “rebalancing” approaches to hemophilia therapy.
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Affiliation(s)
- Moniba Nazeef
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - John P Sheehan
- Department of Medicine, Division of Hematology/Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; UW Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Heparin supplement counteracts the prohemostatic effect of prothrombin complex concentrate and factor IX concentrate: An in vitro evaluation. Thromb Res 2016; 139:102-10. [PMID: 26916304 DOI: 10.1016/j.thromres.2016.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/20/2016] [Accepted: 01/24/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Coagulation factor concentrates like factor IX (FIX) and prothrombin complex concentrate (PCC) can contain anticoagulant substances that may hamper their procoagulant effectiveness in the treatment of hemophilia B or reversal of oral anticoagulation, as well as the laboratory assessment thereof. The aim of the present study was to evaluate the influence of anticoagulant heparin supplement on the prohemostatic potential of different PCCs and FIX concentrates. MATERIALS AND METHODS Prohemostatic potential was evaluated in vitro employing PT/aPTT, thrombography (TGA) and thromboelastography (TEG) with FIX deficient plasma, vitamin K antagonist (VKA)-anticoagulated plasma and plasma anticoagulated with rivaroxaban. RESULTS Most PCCs contained heparin, while heparin was detected in 1 out of 4 examined FIX concentrates. All heparin-containing clotting factor concentrates showed severely hampered prohemostatic effects when therapeutic doses were added to anticoagulated plasmas. Upon heparin removal, comparable prohemostatic effects were observed. Of importance is the notion that the anticoagulant effect of heparin was enhanced by rivaroxaban, resulting in a 7 fold increased PT sensitivity towards heparin in the presence of 500μg/L rivaroxaban. CONCLUSIONS Compositional differences between clotting factor concentrates should be taken into account. Therapeutic levels of heparin may be co-infused when treating emergency bleeds with high prohemostatic drug doses, particularly those recommended in the reversal of non-VKA anticoagulants such as rivaroxaban by PCC. Given the relative short half-life of heparin compared to vitamin K-dependent clotting factors, an anticoagulant heparin effect shortly after concentrate infusion should be considered clinically and while interpreting laboratory coagulation parameters.
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Pérez-Garrido R, Alonso N, Jiménez-Yuste V, Haya S, Zúñiga P, Baques A, Candela M, Dávoli M, Rescia V. Efficacy of factor IX Grifols® in surgery: experience of an international multicentre retrospective study. Haemophilia 2012; 18:e372-3. [DOI: 10.1111/j.1365-2516.2012.02919.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - N. Alonso
- Hospital Infanta Cristina; Badajoz; Spain
| | | | - S. Haya
- Hospital Universitario y Politécnico La Fe; Valencia; Spain
| | - P. Zúñiga
- Hospital de la Universidad Católica de Chile; Santiago; Chile
| | - A. Baques
- Fundación de la Hemofilia; Buenos Aires; Argentina
| | - M. Candela
- Fundación de la Hemofilia; Buenos Aires; Argentina
| | - M. Dávoli
- Sanatorio Americano; Rosario; Argentina
| | - V. Rescia
- Sanatorio Americano; Rosario; Argentina
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BATOROVA A, HOLME P, GRINGERI A, RICHARDS M, HERMANS C, ALTISENT C, LOPEZ-FERNÁNDEZ M, FIJNVANDRAAT K. Continuous infusion in haemophilia: current practice in Europe. Haemophilia 2012; 18:753-9. [DOI: 10.1111/j.1365-2516.2012.02810.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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11
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COPPOLA A, FRANCHINI M, MAKRIS M, SANTAGOSTINO E, DI MINNO G, MANNUCCI PM. Thrombotic adverse events to coagulation factor concentrates for treatment of patients with haemophilia and von Willebrand disease: a systematic review of prospective studies. Haemophilia 2012; 18:e173-87. [DOI: 10.1111/j.1365-2516.2012.02758.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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FRANCHINI M, MAKRIS M, SANTAGOSTINO E, COPPOLA A, MANNUCCI PM. Non-thrombotic-, non-inhibitor-associated adverse reactions to coagulation factor concentrates for treatment of patients with hemophilia and von Willebrand’s disease: a systematic review of prospective studies. Haemophilia 2012; 18:e164-72. [DOI: 10.1111/j.1365-2516.2011.02745.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Erhabor O, Adias TC. From whole blood to component therapy: the economic, supply/demand need for implementation of component therapy in sub-Saharan Africa. Transfus Clin Biol 2011; 18:516-26. [PMID: 22037104 DOI: 10.1016/j.tracli.2011.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 06/26/2011] [Indexed: 11/28/2022]
Abstract
Blood may be transfused as whole blood or as one of its components. Because patients seldom require all of the components of whole blood, it makes sense to transfuse only that portion needed by the patient for a specific condition or disease. This treatment, known as "blood component therapy", allows several patients to benefit from one unit of donated whole blood. Blood components include red blood cells, plasma, platelets, and cryoprecipitate. A considerable literature has accumulated over the past decade indicating that leukocytes present in allogeneic cellular blood components, intended for transfusion, are associated with adverse effects to the recipient. These include the development of febrile transfusion reactions, graft-versus-host disease, alloimmunization to leukocyte antigens, and the immunomodulatory effects that might influence the prognosis of patients with a malignancy. Moreover, it has become evident that such leukocytes may be the vector of infectious agents such as cytomegalovirus (CMV), Human T-Lymphotrophic Virus 1/11 (HTLV-I/II), and Epstein Barr (EBV) as well as other viruses. Effective stewardship of blood ensuring that several patients potentially benefit from components derived from one unit of donated whole blood is important for economic, supply/demand reasons and to protect the national inventory at times of national blood shortage. Blood safety in developing countries can be improved by more appropriate use of blood components rather than whole blood transfusion and the provision of alternatives such as oral and intravenous iron, erythropoietin, saline and colloids. This will facilitate the optimal use of the limited blood supply. Political will and open-mindedness to innovative ways to improve supply, appropriateness, optimal use and safety of blood from all types of donors are essential to promote more evidence-based approaches to blood transfusion practice in sub-Saharan Africa.
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Affiliation(s)
- O Erhabor
- Department of Blood Sciences, Royal Bolton Hospital NHS Trust UK, 4, Minerva Road, BL4 0JR Bolton, United Kingdom.
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WATTS RG, COOK RP. Operative management and outcomes in children with congenital bleeding disorders: a retrospective review at a single haemophilia treatment centre. Haemophilia 2011; 18:421-5. [DOI: 10.1111/j.1365-2516.2011.02667.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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BJÖRKMAN S. A commentary on the differences in pharmacokinetics between recombinant and plasma-derived factor IX and their implications for dosing. Haemophilia 2011; 17:179-84. [DOI: 10.1111/j.1365-2516.2010.02431.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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QUON DVK, LOGAN L. Safety and efficacy of plasma-derived coagulation factor IX concentrate (AlphaNine® SD) in patients with haemophilia B undergoing surgical intervention: a single institution retrospective analysis. Haemophilia 2010; 17:e196-201. [DOI: 10.1111/j.1365-2516.2010.02354.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Zanon E, Sartori MT, Spiezia L, Brandolin B, Simioni P, Manara R. Outcome of Long-Term Prophylaxis After Cerebral Hemorrhage in a Patient With Severe Hemophilia B. Clin Appl Thromb Hemost 2010; 17:535-8. [DOI: 10.1177/1076029610384110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Reports of intracerebral hemorrhage (ICH) in patients with hemophilia B are relatively rare. We describe the first clinical results of the use of a monoclonal antibody purified factor IX (FIX) concentrate (Mononine) after an ICH and the long-term outcome of prophylaxis with this product to prevent recurrences. A 44-year-old male with severe hemophilia B was referred to our department because of nausea, vomiting, left lower limb hemiplegia, and left arm paresis. Computed tomography (CT) revealed a right frontal intraparenchymal bleed. The patient was treated with replacement therapy with FIX for 40 days. Computed tomography scans performed on day 40 after the event showed complete disappearance of the cerebral hematoma from the parenchymal tissue. Subsequently, the patient received 25.6 IU/kg-1 of FIX twice a week. At the 48-month follow-up visit, no more major or minor bleeding events had occurred. Long-term prophylaxis after ICH is recommended.
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Affiliation(s)
- Ezio Zanon
- Department of Cardiologic, Thoracic and Vascular Sciences, 2nd Chair Internal Medicine University of Padua Medical School, Padua, Italy
| | - Maria Teresa Sartori
- Department of Cardiologic, Thoracic and Vascular Sciences, 2nd Chair Internal Medicine University of Padua Medical School, Padua, Italy
| | - Luca Spiezia
- Department of Cardiologic, Thoracic and Vascular Sciences, 2nd Chair Internal Medicine University of Padua Medical School, Padua, Italy
| | - Barbara Brandolin
- Department of Cardiologic, Thoracic and Vascular Sciences, 2nd Chair Internal Medicine University of Padua Medical School, Padua, Italy
| | - Paolo Simioni
- Department of Cardiologic, Thoracic and Vascular Sciences, 2nd Chair Internal Medicine University of Padua Medical School, Padua, Italy
| | - Renzo Manara
- Neuroradiology, University of Padua Medical School, Padua, Italy
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HERMANS C, ALTISENT C, BATOROVA A, CHAMBOST H, DE MOERLOOSE P, KARAFOULIDOU A, KLAMROTH R, RICHARDS M, WHITE B, DOLAN G. Replacement therapy for invasive procedures in patients with haemophilia: literature review, European survey and recommendations. Haemophilia 2009; 15:639-58. [DOI: 10.1111/j.1365-2516.2008.01950.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Secondary prophylaxis with factor IX concentrates: continuous infusion. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2009; 6 Suppl 2:s21-5. [PMID: 19105506 DOI: 10.2450/2008.0033-08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Haemophilia patients may require prolonged treatment during peri-operative period or life-threatening bleedings. Intermittent bolus infusions of factor concentrates have been used successfully for many years. However, pharmacokinetics may vary among products and patients, and the wide fluctuations in factor levels during therapy can make management inaccurate and unsafe. Specific protocols for continuous infusion have been developed, which may decrease factor utilization, facilitate laboratory monitoring of factor levels, and may decrease the overall cost of therapy. Continuous infusion of different clotting factor concentrates (factor VIII, factor IX, porcine factor VIII, rFVIIa, and activated prothrombin complex concentrates) has been associated with excellent haemostasis and safety: indeed, by continuous infusion unsafe low troughs or dangerous high concentrations can be avoided. In this review, the pharmacokinetic aspects of the continuous infusion of plasma-derived and recombinant factor IX concentrates are showed. Finally, the advantages and disadvantages of continuous infusion are discussed.
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KRAKOW EF, WALKER I, LAMY A, ANDERSON JAM. Cardiac surgery in patients with haemophilia B: a case report and review of the literature. Haemophilia 2009; 15:108-13. [DOI: 10.1111/j.1365-2516.2008.01918.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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MORFINI M, LAGUNA P, LEISSINGER C. Factor IX pharmacokinetics: differences between plasma-derived and recombinant products and the clinical and economic implications: a meeting report. Haemophilia 2008; 14:873-5. [DOI: 10.1111/j.1365-2516.2008.01762.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
PURPOSE OF REVIEW To review the most recent reports on continuous infusion of coagulation factors, focusing on the current issues relating to this mode of therapy. RECENT FINDINGS Continuous infusion has been extensively used as an alternative to intermittent bolus factor replacement since the 1990s. To date, more than 100 reports comprising more than 800 continuous infusion treatments in various clinical situations have been published, with an increase in the current utilization of recombinant coagulation factors. An excellent hemostatic efficacy of continuous infusion has been reported. Continuous infusion protocols, however, still vary widely in terms of the different hemostatic levels targeted, dosage regimens, modes of continuous infusion and duration of therapy, which obviously result in variations in the cost-effectiveness reported by different centers. SUMMARY Continuous infusion has been shown to be a safe and cost-effective mode of replacement for treatment of hemophilia. The lack of evidence-based information on the hemostatic levels to be maintained in specific clinical situations, and recent concerns regarding the development of inhibitors, particularly in patients with mild hemophilia treated with continuous infusion, need to be addressed by prospective, randomized studies that compare traditional intermittent injections and the continuous infusion mode of factor replacement.
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Affiliation(s)
- Angelika Batorova
- National Hemophilia Center, University Hospital, Bratislava, Slovak Republic, Israel
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Shapiro AD, Korth-Bradley J, Poon MC. Use of pharmacokinetics in the coagulation factor treatment of patients with haemophilia. Haemophilia 2005; 11:571-82. [PMID: 16236106 DOI: 10.1111/j.1365-2516.2005.01149.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Dosing decisions for replacement coagulation factors in patients with haemophilia should be made on an individual patient basis, with the required dose dependent on factors including the clinical situation, the severity of the factor deficiency, and the location and extent of bleeding. Moreover, there is considerable variability in the pharmacokinetics of coagulation products that needs to be considered; in particular, with both factor (F) IX and FVIII products, there is considerable inter-patient variability in in vivo recovery and terminal half-life values. In the present report, we provide a practical guide to calculating and applying pharmacokinetic parameters relevant to the optimal dosing of coagulation products. We discuss the conduct of a pharmacokinetic study in an individual patient, how to calculate pharmacokinetic values from raw data and clinical situations where an individual pharmacokinetic study is helpful. We highlight the importance of considering an individual pharmacokinetic study in all patients starting a new coagulation product.
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Affiliation(s)
- A D Shapiro
- Indiana Hemophilia and Thrombosis Center, Inc., Indianapolis, IN 46260, USA.
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Abstract
The mainstay of the management of haemophilia is the replacement of clotting factors, using clotting factor concentrates (CFC) in a way that prevents bleeding and its complications. Beginning with small doses, as whole blood and plasma over 50 years ago, highly purified CFCs are now administered frequently in large doses to effectively treat this condition so that even people with severe haemophilia can lead near normal lives. However, with such regimens, compliance and expense have both become significant issues. The question therefore is whether the current models of clotting factor replacement are optimal. This article reviews the literature on the dose-response relationship in haemophilia, with particular reference to management of musculoskeletal bleeding and surgical haemostasis. Current practices are based on uncontrolled observational data. Less intensive protocols could achieve similar outcomes. Large multi-centre prospective studies are needed to provide comparative data on unresolved issues so that factor replacement therapy can be optimized, based on evidence.
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Affiliation(s)
- Alok Srivastava
- Department of Haematology, Christian Medical College, Vellore, India.
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25
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Abstract
Considerations for treatment of hemophilia B patients in high-risk settings are the focus of this paper, including differences in recoveries of factor IX products and variable patient responses to replacement therapy. Data support the importance of performing individual pharmacokinetic studies in determining treatment programs for hemophilia patients-for both high-risk periods such as surgery and for prophylaxis. Other considerations in choice of plasma-derived or recombinant factor IX concentrate in high-risk and other situations include product safety, cost, and availability.
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Affiliation(s)
- Anaadriana Zakarija
- Department of Hematology/Oncology, Northwestern University, Chicago, Illinois, USA.
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Douvas MG, Monahan PE. Life-threatening thrombosis complicating the management of hepatic hemorrhage: anticoagulant treatment in a newborn with hemophilia B. J Pediatr Hematol Oncol 2004; 26:258-63. [PMID: 15087956 DOI: 10.1097/00043426-200404000-00010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors report the case of a neonate presenting with a distended abdomen and shock from factor IX (F.IX) deficiency and intrahepatic bleeding. After resuscitation and treatment with recombinant F.IX through a central venous line, he developed superior vena cava, upper extremity, and intracerebral venous thrombosis resulting in superior vena cava syndrome and intrathalamic hemorrhage. He was treated with F.IX to achieve near-normal F.IX activity levels and with low-dose unfractionated heparin with clinical improvement. F.IX replacement on a subsequent admission was again complicated by upper venous system thrombosis and improved with low-dose heparin. The case illustrates an unusual presentation of hemophilia, life-threatening thrombotic complications associated with factor replacement, and a strategy for anticoagulant management in the setting of hemophilic bleeding.
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Affiliation(s)
- Michael Gregory Douvas
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, USA.
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