Treatment of haemophilia A by continuous Factor VIII infusion

Hawkins, Tim E.; Green, G. J.; Romeril, Kenneth; Milicich, G. S.; Carter, J. M.

doi:10.1111/j.1445-5994.1995.tb00576.x

Cited by 7 publications

(5 citation statements)

References 1 publication

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“…In other studies [ 6, 26], procedures included total knee/hip replacements, renal stone surgery, splenectomy, and open heart surgery. In a number of studies [ 2, 5, 6, 27] the use of tranexamic acid and fibrin glue could have contributed to reductions in FVIII consumption.…”

Section: Discussionmentioning

confidence: 99%

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Continuous infusion of intermediate‐purity factor VIII in haemophilia A patients undergoing elective surgery

et al. 1999

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An open, non-randomized trial of continuous infusion therapy was conducted involving five patients with severe haemophilia A who required factor VIII (FVIII) prophylaxis for elective surgery. This was preceded by a 24-h preoperative pharmacokinetic study to characterize the pharmacokinetic parameters of each individual patient following a bolus dose of the intermediate-purity product. A retrospective matched control group was identified to allow for comparisons of FVIII usage between bolus and continuous infusion administration. A loading dose of FVIII was administered preoperatively, and the continuous infusion was started at the end of surgery and continued for 5 days. The patients' FVIII levels, vital signs, and infusion sites were monitored on a daily basis. The clearance was re-calculated on a daily basis using the FVIII activity of that day to adjust the infusion rate to achieve the desired FVIII level. The mean (CV%) pharmacokinetic parameters estimated preoperatively by noncompartmental analysis were: clearance 3.2 mL kg-1 h-1 (35.5%), volume of distribution 52.1 mL kg-1 (40.2%), mean residence time 17.4 h (23.3%), and half-life 12.7 h (23.6%). A progressive decrease in the clearance of FVIII from a mean of 3.1 mL kg-1 h-1 to 2.0 mL kg-1 h-1 (P = 0.125) over the first 5 days was observed. A therapeutically acceptable level of FVIII was systematically achieved, with the only complication being frequent thrombophlebitis. On average the patients used 19% less FVIII when compared with matched historical controls (P = 0.25). This method was found to be safe and effective in haemophilia A patients undergoing elective surgery procedures.

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Section: Discussionmentioning

confidence: 99%

“…Continuous infusion therapy has been suggested to maintain a steady plasma level of FVIII activity above that at which there is a risk of bleeding. Although continuous infusion has been shown to be safe, effective, and practical [ 1–6], it is not widely used, and clinical experience is still lacking with some FVIII concentrates.…”

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confidence: 99%

Continuous infusion of intermediate‐purity factor VIII in haemophilia A patients undergoing elective surgery

et al. 1999

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“…The administration of continuous FVIII infusion was evaluated in 2 patients. 29 A 58-year-old man with severe hemophilia A underwent an elective long femoral intramedullary rod placement for a chronic fracture of the distal femur. During the first week of continuous therapy, the patient received a mean infusion rate of 1.74 units/kg/h of FVIII.…”

Section: Surgical Prophylaxismentioning

confidence: 99%

Continuous Infusion of Coagulation Factor Products

Stachnik

Gabay

2002

Ann Pharmacother

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Administration of factor products (factor VIII and recombinant factor VIIa) via continuous infusion has produced favorable hemostatic effects compared with intermittent bolus injections. The advantages of continuous infusion include maintenance of a constant factor concentration, thereby reducing risk of bleeding from excessively low trough concentrations, and a decrease in factor consumption related to a reduction in factor clearance with constant infusion. Manufacturers recommend using reconstituted factor products either immediately or within 1-3 hours after reconstitution; however, several studies have found the products to be stable and sterile for longer periods.

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“…Treatment protocols include pre-and postoperative attainment of normal factor VIII levels during the course of treatment and for 2 to 3 weeks postoperatively depending on the procedure. A newer approach to surgical management includes that of continuous infusion of product rather than a bolus every 8 hours [39]. This regimen appears to produce a more stable level of factor VIII and may require approximately 30% less of the product overall.…”

Section: To Enhance Autologous Donationmentioning

confidence: 99%

Recombinant Blood Components: Clinical Administration Today and Tomorrow

Growe

1996

World j. surg.

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Improvements in the technology of whole blood fractionation have resulted in the development of many subfractions that allow more specific management of clotting deficiencies, such as the hemophilias. Infective disasters have occurred in recent years, which has led to concern regarding the use of human blood components. There has been great interest in the search for alternatives, such as synthetic volume expanders, antifibrinolytic drugs, and hormones to stimulate bone marrow production. Recombinant technology has developed rapidly over the past 15 years, and several products are now available for use, including recombinant factor VIII and recombinant factor VIIa for the treatment of hemophilia and recombinant erythropoietin to stimulate red blood cell production. As these recombinant proteins are complex, they require mammalian cell lines as their substrate. Recombinant processes have the potential to produce sufficient quantities of these products for the treatment of patients around the world independent of a human plasma source. The introduction of all of the new recombinant products has been done in an orderly fashion through clinical trials. Erythropoietin was extensively reviewed initially for its effect in chronic renal failure patients and appears to have other applications. Recombinant factor VIII has now become a mainstay of treatment for many patients with hemophilia A, and recombinant factor VIIa has a major role to play in the management of patients with inhibitors to factors VIII and IX. We anticipate the availability of other recombinant blood proteins soon.

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Treatment of haemophilia A by continuous Factor VIII infusion

Cited by 7 publications

References 1 publication

Continuous infusion of intermediate‐purity factor VIII in haemophilia A patients undergoing elective surgery

Continuous infusion of intermediate‐purity factor VIII in haemophilia A patients undergoing elective surgery

Continuous Infusion of Coagulation Factor Products

Recombinant Blood Components: Clinical Administration Today and Tomorrow

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