Two retrospective studies have suggested that exposure to factor VIII (FVIII) in early infancy is associated with an increased risk of FVIII inhibitor development. We prospectively studied 11 infants who needed replacement therapy for bleeding episodes before the age of 2 years. They received activated recombinant factor VII (rFVIIa) concentrate on demand, with the intention of postponing their first exposure to FVIII after 2 years of age. Thirty-three bleeding episodes were treated with 154 doses of rFVIIa with no evidence of adverse effect. Bleeding was controlled in 27 of 33 episodes. Mouth bleeds were most difficult to treat. The use of rFVIIa allowed postponement of the use of FVIII for a mean of 5.5 months (median 4, range 0-12) but in only three of 11 children could be the first exposure to factor postponed after the age of 2 years. With this modest effect of rFVIIa in postponing the first exposure to FVIII, more convincing evidence for the benefit of such a postponement will have to be demonstrated before rFVIIa could be recommended for this indication.

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Background Clinical safety is an essential component of health care quality. The EVADUR study showed that 12% of patients who were in the emergency department (ED) had adverse events (AE). 70% of them were considered avoidable. Purpose To describe pharmaceutical interventions (PI) conducted by a pharmaceutical care system (PCP) in an ED and calculate the impact of its continuous implementation. Materials and methods We conducted a two-month descriptive study about PCP in ED. The system consisted of monitoring pharmacotherapy and detecting drug-related problems (DRP) of patients who had to be admitted and stay in the ED for 24 h. It also included checking stock medicines, monitoring restricted drugs, pharmacovigilance and drug information. 2 h a day was allocated for the PI. We excluded psychiatry, gynaecology and emergency paediatrics. We adapt and modify the classification of PI according to the Granada Third Consensus on PI indication, efficacy and safety. Results During the study 1402 patients were admitted to the hospital from the ED, 351 (25%) of whom benefited from the PCP. We conducted 103 PI. The greater percentage of problems was omission of necessary medicines (23.3%), followed by adjustment of the medicines to the hospital guidelines (17.5%) and medicines that were not needed during the stay in the ED (9.7%). Classification of PI was similar between indication, efficacy and safety (37.9%, 31.1% and 31.1%, respectively). 79.6% of PI were accepted. Extrapolating data, if PCP had been applied to all patients admitted to hospital from the ED, it could have made ??412 PI. Conclusions The presence of a pharmacist in the ED improves the detection, registration and resolution of DRP. A full-time pharmacist in the ED would optimise pharmacotherapy for all patients and resolve queries. Future studies are needed that allow us to determine the impact of this intervention when the patient is hospitalised. No conflict of interest.

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