The efficacy of bypassing agents in surgery of hemophilia patients with inhibitors

Ju, Hee Young; Jang, Hyung Suk; Park, Young Shil

doi:10.5045/br.2015.50.3.173

Cited by 24 publications

(23 citation statements)

References 19 publications

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“…667 Further studies document that both rFVIIa and aPCC can be used successfully perioperatively. 525,668,669 In the absence of comparative studies carried out in the surgical setting, then personal experience, availability and cost may guide the choice of the bypassing agents. 670 The choice of product in patients with hightitre inhibitors is highly individualised, and depends on the age of the patient, prior exposure to plasma products, type of bleeding, volume of reconstitution, cost, efficacy and safety.…”

Section: Haemophilia a And B Recommendationsmentioning

confidence: 99%

Management of severe perioperative bleeding

Kozek‐Langenecker

Ahmed

Afshari

et al. 2017

European Journal of Anaesthesiology

693

316

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: The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide healthcare professionals with an overview of the most recent evidence to help ensure improved clinical management of patients. For this update, electronic databases were searched without language restrictions from 2011 or 2012 (depending on the search) until 2015. These searches produced 18 334 articles. All articles were assessed and the existing 2013 guidelines were revised to take account of new evidence. This update includes revisions to existing recommendations with respect to the wording, or changes in the grade of recommendation, and also the addition of new recommendations. The final draft guideline was posted on the European Society of Anaesthesiology website for four weeks for review. All comments were collated and the guidelines were amended as appropriate. This publication reflects the output of this work.

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Section: Haemophilia a And B Recommendationsmentioning

confidence: 99%

Management of severe perioperative bleeding

Kozek‐Langenecker

Ahmed

Afshari

et al. 2017

European Journal of Anaesthesiology

693

316

View full text Add to dashboard Cite

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“…Surgery for arthropathy represents a crucial problem in patients with hemophilia, and the costs in patients with inhibitors are much higher than in those without inhibitors. However, data regarding the use of bypassing agents during surgical procedures are limited . The high costs associated with surgery varied according to the specific procedure; however, patients undergoing surgical procedures reported higher costs than patients without surgery …”

Section: Discussionmentioning

confidence: 99%

“…However, data regarding the use of bypassing agents during surgical procedures are limited. 83 The high costs associated with surgery varied according to the specific procedure; however, patients undergoing surgical procedures reported higher costs than patients without surgery. 51 New emerging treatments will be licensed to be placed on the market and big expectation are put on their impact on patient care and management, especially for patients with inhibitors.…”

Section: Discussionmentioning

confidence: 99%

The socioeconomic burden of patients affected by hemophilia with inhibitors

D’Angiolella

Cortesi

Rocino

et al. 2018

European J of Haematology

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Hemophilia is associated with a high financial burden on individuals, healthcare systems, and society. The development of inhibitors significantly increases the socioeconomic burden of the diseases. This study aimed to review and describe the burden of hemophilia with inhibitors, providing a reference scenario to assess the impact of new products in the real word. Two systematic literature reviews were performed to collect data on (i) health economics and (ii) health‐related quality of life evidences in hemophilic patients with inhibitors. The costs associated with patients with hemophilia and inhibitors are more than 3 times greater than the costs incurred in those without inhibitors, with an annual cost per patient that can be higher than €1 000 000. The costs of bypassing agents account for the large majority of the total healthcare direct costs for hemophilia treatment. The quality of life is more compromised in patients with hemophilia and inhibitors compared to those without inhibitors, in particular the physical domains, whereas mental domains were comparable to that of the general population. The development of an inhibitor has a high impact on costs and quality of life. New treatments have the potential to change positively the management and socioeconomic burden of hemophilia with inhibitors.

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“…Ju et al present one of the larger series involving 15 patients and 25 orthopaedic procedures. Only one patient was noted to have complications, they underwent two total knee replacements and required sequential bypassing therapy in one knee with a switch in therapy from NovoSeven to FEIBA in the other.…”

Section: Literature Reviewmentioning

confidence: 99%

Over two decades of orthopaedic surgery in patients with inhibitors—Quantifying the complication of bleeding

et al. 2018

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Patients with haemophilia who have developed inhibitors against factor VIII (FVIII) or factor IX present a significant concern to those surgeons who operate on them. The evidence base for bypassing agents such as recombinant factor VIIa and activated prothrombin complex concentrate has amassed over several decades. The literature is open to positive interpretation on the successful use of these agents in the treatment of inhibitor‐positive patients. However, there are equally persistent concerns amongst surgeons, in particular orthopaedic surgeons, regarding the high complication rate of bleeding. To explore and quantify this concern, we present a literature review spanning two decades of publications on haemophilia patients with inhibitors undergoing orthopaedic surgery. Irrespective of the progress made with haemostatic protocols, trepidation on embarking on surgery is valid. The high risk of bleeding is a function of the inherent complexity of the disease and rightfully translates into difficulties in its management. Combined with the prospect of orthopaedic surgery, those involved in the care of such patients are justified in their continued anxiety and diligence when considering the benefits in quality of life against the prevalent complications.

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The efficacy of bypassing agents in surgery of hemophilia patients with inhibitors

Cited by 24 publications

References 19 publications

Management of severe perioperative bleeding

Management of severe perioperative bleeding

The socioeconomic burden of patients affected by hemophilia with inhibitors

Over two decades of orthopaedic surgery in patients with inhibitors—Quantifying the complication of bleeding

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