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Gopalakrishnan N, Usha T, Thopalan B, Dhanapriya J, Dineshkumar T, Thirumalvalavan K, Sakthirajan R. Hemodialysis in a patient with severe hemophilia A and factor VIII inhibitor. Hemodial Int 2016; 20:E11-E13. [DOI: 10.1111/hdi.12429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Natarajan Gopalakrishnan
- Department of Nephrology; Madras Medical College & Rajiv Gandhi Government General Hospital; Chennai Tamil Nadu 600003 India
| | - Thiruvengadam Usha
- Department of Nephrology; Madras Medical College & Rajiv Gandhi Government General Hospital; Chennai Tamil Nadu 600003 India
| | - Balasubramaniyan Thopalan
- Department of Nephrology; Madras Medical College & Rajiv Gandhi Government General Hospital; Chennai Tamil Nadu 600003 India
| | - Jeyachandran Dhanapriya
- Department of Nephrology; Madras Medical College & Rajiv Gandhi Government General Hospital; Chennai Tamil Nadu 600003 India
| | - Thanigachalam Dineshkumar
- Department of Nephrology; Madras Medical College & Rajiv Gandhi Government General Hospital; Chennai Tamil Nadu 600003 India
| | - Kaliaperumal Thirumalvalavan
- Department of Nephrology; Madras Medical College & Rajiv Gandhi Government General Hospital; Chennai Tamil Nadu 600003 India
| | - Ramanathan Sakthirajan
- Department of Nephrology; Madras Medical College & Rajiv Gandhi Government General Hospital; Chennai Tamil Nadu 600003 India
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2
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How I use bypassing therapy for prophylaxis in patients with hemophilia A and inhibitors. Blood 2015; 126:153-9. [DOI: 10.1182/blood-2014-10-551952] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 03/25/2015] [Indexed: 11/20/2022] Open
Abstract
Abstract
Inhibitor development poses a significant challenge in the management of hemophilia because once an inhibitor is present, bleeding episodes can no longer be treated with standard clotting factor replacement therapy. Consequently, patients with inhibitors are at increased risk for difficult-to-control bleeding and complications, particularly arthropathy and physical disability. Three clinical trials in patients with inhibitors have demonstrated that prophylaxis with a bypassing agent reduces joint and other types of bleeding and improves health-related quality of life compared with on-demand bypassing therapy. In hemophilia patients without inhibitors, the initiation of prophylaxis with factor (F) VIII or FIX prior to the onset of recurrent hemarthroses can prevent the development of joint disease. Whether this is also true for bypassing agent prophylaxis remains to be determined.
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Valentino LA, Holme PA. Should anti-inhibitor coagulant complex and tranexamic acid be used concomitantly? Haemophilia 2015; 21:709-14. [DOI: 10.1111/hae.12723] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - P. A. Holme
- Research Institute of Internal Medicine; Institute of Clinical Medicine; Oslo Norway
- Department of Hematology; Oslo University Hospital Rikshospitalet; Oslo Norway
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Leissinger CA, Konkle BA, Antunes SV. Prevention of bleeding in hemophilia patients with high-titer inhibitors. Expert Rev Hematol 2015; 8:375-82. [DOI: 10.1586/17474086.2015.1036733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Faranoush M, Abolghasemi H, Mahboudi F, Toogeh G, Karimi M, Eshghi P, Managhchi M, Hoorfar H, Dehdezi BK, Mehrvar A, khoeiny B, Vaziri B, Kamyar K, Heshmat R, Baghaeipour MR, Mirbehbahani NB, Fayazfar R, Ahmadinejad M, Naderi M. A Comparison of Efficacy Between Recombinant Activated Factor VII (Aryoseven) and Novoseven in Patients With Hereditary FVIII Deficiency With Inhibitor. Clin Appl Thromb Hemost 2014; 22:184-90. [DOI: 10.1177/1076029614555902] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction: This study compared the efficacy of Aryoseven with Novoseven to control bleeding episodes in patients with hemophilia A with inhibitors. Methods: Sixty-six patients were randomized into 2 groups, with 4 consecutive block randomization. These groups received Aryoseven and Novoseven dosages of 90 to 120 μg/kg intravenously every 2 hours. Results: Median (interquartile range) level of factor VIII (FVIII) inhibitor in groups A and B was 15.0 and 19.0 Bethesda Unit (BU) preadministration. Bleeding onset in group A was 1246 ± 1104 minutes and in group B was 2301 ± 1693 minutes ( P = .311). The Kavakli global response scores and treatment success rate was comparable in both the groups. The side effects in groups A (9.7%) and B (2.9%) were comparable. Conclusion: Biosimilar recombinant activated FVII is found to be as effective as Novoseven in the treatment of acute joint bleeding in patients with hemophilia with inhibitors. Its usage will decrease the gaps in hemophilia.
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Affiliation(s)
- M. Faranoush
- Iran university of Medical Sciences, Rasool Akram Hospital, Tehran, Iran
| | - H. Abolghasemi
- Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F. Mahboudi
- Biotechnology Research Center, Pasteur Institute of Iran, Tehran Iran
| | - Gh. Toogeh
- Thrombosis and Hemostasis Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran
| | - M. Karimi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - P. Eshghi
- Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M. Managhchi
- Thrombosis and Hemostasis Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran
| | - H. Hoorfar
- Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | | | - B. Vaziri
- Biotechnology Research Center, Pasteur Institute of Iran, Tehran Iran
| | - K. Kamyar
- Aryogen Zist Darou Company, Karaj, Iran
| | - R. Heshmat
- Thrombosis and Hemostasis Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital, Tehran, Iran
| | | | | | - R. Fayazfar
- MD, Kerman University of Medical Sciences, Kerman, Iran
| | - M. Ahmadinejad
- High Institute of Research, Iranian Blood Transfusion Organization, Tehran, Iran
| | - M. Naderi
- Zahedan University of Medical Sciences, Ahwaz, Iran
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BERNTORP E, COLLINS P, D’OIRON R, EWING N, GRINGERI A, NÉGRIER C, YOUNG G. Identifying non-responsive bleeding episodes in patients with haemophilia and inhibitors: a consensus definition. Haemophilia 2010; 17:e202-10. [DOI: 10.1111/j.1365-2516.2010.02377.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Thrombophilias, an inherited and/or acquired predisposition to vascular thrombosis beyond hemostatic needs are common in cardiovascular medicine and include systemic disorders such as coronary atherosclerosis, atrial fibrillation, exogenous obesity, metabolic syndrome, collagen vascular disease, human immunodeficiency virus, blood replacement therapy and several commonly used medications. A contemporary approach to patients with suspected thrombophilias, in addition to a very selective investigation for gain-of-function and loss-of-function gene mutations affecting thromboresistance, must consider prevalent diseases and management decisions encountered regularly by cardiologists in clinical practice. An appropriate recognition of common disease states as thrombophilias will also stimulate platforms for much needed scientific investigation.
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Affiliation(s)
- Richard C Becker
- Divisions of Cardiology and Hematology, Duke University School of Medicine, Duke Clinical Research Institute, 2400 Pratt Street, DUMC 3850, Durham, NC 27705, USA.
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SCALONE L, MANTOVANI LG, BORGHETTI F, VON MACKENSEN S, GRINGERI A. Patients’, physicians’, and pharmacists’ preferences towards coagulation factor concentrates to treat haemophilia with inhibitors: results from the COHIBA Study. Haemophilia 2009; 15:473-86. [DOI: 10.1111/j.1365-2516.2008.01926.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pratt KP, Thompson AR. B-Cell and T-Cell Epitopes in Anti-factor VIII Immune Responses. Clin Rev Allergy Immunol 2009; 37:80-95. [DOI: 10.1007/s12016-009-8120-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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11
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Balsam LB, Timek TA, Pelletier MP. Factor Eight Inhibitor Bypassing Activity (FEIBA) for Refractory Bleeding in Cardiac Surgery: Review of Clinical Outcomes. J Card Surg 2008; 23:614-21. [DOI: 10.1111/j.1540-8191.2008.00686.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Leora B. Balsam
- Stanford Program in Cardiac Surgery at El Camino Hospital, Mountain View, California
| | - Tomasz A. Timek
- Stanford Program in Cardiac Surgery at El Camino Hospital, Mountain View, California
| | - Marc P. Pelletier
- Stanford Program in Cardiac Surgery at El Camino Hospital, Mountain View, California
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12
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Gomperts ED, Astermark J, Gringeri A, Teitel J. From theory to practice: applying current clinical knowledge and treatment strategies to the care of hemophilia a patients with inhibitors. Blood Rev 2008; 22 Suppl 1:S1-11. [PMID: 18485996 DOI: 10.1016/s0268-960x(08)70001-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Two bypassing agents are currently available to circumvent the need for factor FVIII in hemophilia A patients with inhibitors: the activated prothrombin complex FEIBA VH and recombinant activated factor VII (NovoSeven. Both products are highly effective in controlling bleeding in the presence of inhibitory alloantibodies, yet their hemostatic efficacy can be unpredictable. As the results of the FEIBA NovoSeven( Comparative (FENOC) study illustrate, patients may respond better to one bypassing agent than the other. Furthermore, guidelines from an expert panel reflect that responsiveness to bypassing therapy may change from one bleed to the next in the same patient and even from hour to hour during the course of a single bleeding event. These findings underscore the need to have both bypassing products available to treat bleeding episodes in inhibitor patients, to frequently evaluate the efficacy of hemostasis during the course of a bleeding event, and to switch products early if the response to treatment is unsatisfactory.
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Affiliation(s)
- Edward D Gomperts
- Children's Hospital Los Angeles, Division of Hematology/Oncology, 4650 Sunset Blvd., M/S #54, Los Angeles, California 90027, USA.
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Teitel J, Berntorp E, Collins P, D'Oiron R, Ewenstein B, Gomperts E, Goudemand J, Gringeri A, Key N, Leissinger C, Monahan P, Young G. A systematic approach to controlling problem bleeds in patients with severe congenital haemophilia A and high-titre inhibitors. Haemophilia 2007; 13:256-63. [PMID: 17498074 DOI: 10.1111/j.1365-2516.2007.01449.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED The presence of inhibitory antibodies to clotting factors complicates the treatment of bleeding in haemophilia patients. For patients with high-titre inhibitors, bypassing agents are essential to haemostatic management. To determine optimal treatment practices, an international panel of physicians convened to develop a systematic treatment approach for problem bleeds (i.e. bleeds that are unresponsive to initial therapy with a single agent within a reasonable amount of time) in haemophilia patients with inhibitors. AIM The goal of this panel was to develop a consensus algorithm that would aid physicians in considering a variety of treatment approaches to optimize patient care by preventing extensive therapy with inadequate treatments that may lead to suboptimal patient outcomes and unnecessary costs. METHODS Consensus opinions were analyzed for clinical preferences at different time periods, depending on patient response to treatment. Decision-making points were defined based on the type of bleed: every 8-12 h for the first 24 h, then every 24 h thereafter for limb-threatening bleeds; every 2-4 h for 2-7 days for life-threatening bleeds. RESULTS The resultant consensus guidelines provide a generalized methodology to guide the treatment of problem bleeds in patients with severe haemophilia A and inhibitors, and emphasize changing treatment at the first sign of an inadequate haemostatic response. The treatment algorithms apply to both paediatric and adult patients, although the differences between the two groups were reviewed. CONCLUSION These guidelines are focused on optimising the timing of treatment decisions, which may lead to faster responses and improved outcomes.
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Affiliation(s)
- J Teitel
- St Michael's Hospital, Toronto, ON, Canada.
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15
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Ozelo MC, Villaça PR, De Almeida JOSC, Bueno TMF, De Miranda PAP, Hart WM, Karamalis M. A cost evaluation of treatment alternatives for mild-to-moderate bleeding episodes in patients with haemophilia and inhibitors in Brazil. Haemophilia 2007; 13:462-9. [PMID: 17880430 DOI: 10.1111/j.1365-2516.2007.01522.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The first-line treatment for mild-to-moderate bleeding episodes in patients with haemophilia and inhibitors in Brazil is currently activated prothrombin complex concentrate (aPCC), with recombinant activated factor VII (rFVIIa) used as second-line therapy or as a last resort. The aim of this study was to determine the cost and effectiveness of these treatments from the perspective of the Brazilian National Health Service. A decision analysis model was constructed to assess total direct medical costs (including drug costs, costs of outpatient or inpatient care, ambulance transportation and cost of concomitant medications) of first-line treatment with aPCC or rFVIIa. Clinical outcome and resource utilization data were obtained both retrospectively and prospectively and validated by the consensus of an expert panel of Brazilian haematologists. A total of 103 bleeds in 25 patients were included in the analysis. rFVIIa resolved bleeds more quickly (4.4 h) than aPCC (62.6 h) and was more effective (100% vs. 56.7% respectively). Mean total direct medical costs (from initiation to cessation of bleed) were estimated to be US$13 500 (aPCC) and US$7590 (rFVIIa). Extensive sensitivity analyses confirmed the cost-effectiveness of rFVIIa. Compared with aPCC, rFVIIa was more effective and less expensive when used as first-line treatment for mild-to-moderate bleeding episodes in patients with haemophilia and inhibitors in Brazil. rFVIIa should be considered a first-line treatment for the management of these patients.
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Affiliation(s)
- M C Ozelo
- Hemocentro da UNICAMP, Rua Carlos Chagas, CEP 13084-878 Campinas, São Paulo, Brazil.
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Abstract
Clotting factor transfusions are vital for people with diseases such as haemophilia. In the 1970s and 1980s, transfusions with pooled plasma led to a devastatingly high number of recipients becoming infected with blood-borne pathogens such as HIV and hepatitis C. This epidemic triggered the development of virus-free factor concentrates through a combination of improved donor selection and screening, effective virucidal technologies, and recombinant protein expression biotechnology. There is now a wide range of recombinant factor concentrates, and an impressive safety record with respect to pathogen transmission. However, remaining therapeutic challenges include the potential threat of transmission of prions and other pathogens, the formation of inhibitory alloantibodies, and the international disparity that exists in product availability due to differences in licensure status as well as prohibitively high costs. In the future, it is likely that bioengineered recombinant proteins that have been modified to enhance pharmacokinetic properties or reduce immunogenicity, or both, will be used increasingly in clinical practice.
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Affiliation(s)
- Nigel S Key
- University of North Carolina School of Medicine and Harold R Roberts Comprehensive Hemophilia Diagnostic and Treatment Center, Chapel Hill, NC, USA.
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Ng HJ, Lee LH. Recombinant activated clotting factor VII (rFVIIa) in the treatment of surgical and spontaneous bleeding episodes in hemophilic patients. Vasc Health Risk Manag 2007; 2:433-40. [PMID: 17323597 PMCID: PMC1994012 DOI: 10.2147/vhrm.2006.2.4.433] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Inhibitors against replacement clotting factors occur in approximately 30%–40% of patients with hemophilia A and 1.5%–3% of patients with hemophilia B. In this group of patients, bleeding events are best treated with bypassing agents. Recombinant activated factor VII (rFVIIa) has become the first-line agent in treating surgical and non-surgical bleeding in many centres with efficacy at standard 90 μg/kg doses approaching 90%. The greater efficacy is associated with early initiation of treatment, as well as, possibly larger doses of rFVIIa. A higher concentration appears to be essential in initiating an adequate thrombin burst, which results in a stable clot. Higher dosage regimens, home therapy and continuous infusion regimens are continuously evolving as we strive to define optimal dosing strategies in hemophilia patients. rFVIIa has been a remarkably safe agent for hemophiliacs but with high dosages being advocated and older patients being given such doses outside a trial setting, thromboembolic events remain a concern.
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Affiliation(s)
- Heng Joo Ng
- Department of Haematology, Singapore General Hospital, Singapore.
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Abstract
A 9-month-old boy presented with multiple hemorrhagic subcutaneous nodules after treatment with oral antibiotics for an upper respiratory tract infection. Excessive bleeding after an incisional biopsy led to a diagnosis of hemophilia A. While this was an unexpected presentation of hemophilia, screening laboratory coagulation studies prior to biopsy would have revealed the etiology. Similar presentations should alert dermatologists to suspect an underlying coagulation defect prior to biopsy, thus averting bleeding complications.
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Affiliation(s)
- Georganna Davis
- Division of Dermatology, Scott and White Memorial Hospital, Scott, Sherwood and Brindley Foundation, The Texas A&M University System Health Science Center College of Medicine, Temple, Texas, USA.
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Katsumi A, Matsushita T, Hirashima K, Iwasaki T, Adachi T, Yamamoto K, Kojima T, Takamatsu J, Saito H, Naoe T. Recurrent intramural hematoma of the small intestine in a severe hemophilia A patient with a high titer of factor VIII inhibitor: a case report and review of the literature. Int J Hematol 2006; 84:166-9. [PMID: 16926140 DOI: 10.1532/ijh97.06053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 17-year-old man with severe hemophilia A (factor VIII <1%) developed intermittent left upper quadrant pain. He had a high titer of factor VIII inhibitor (1024 Bethesda units/mL) and was diagnosed with intramural hematoma of the jejunum. He was managed conservatively with activated prothrombin complex concentrate (APCC), resulting in the resolution of symptoms. He developed recurrent intramural hematoma of the small intestine over the next 54 months, and was successfully treated with APCC. This case highlights a rare clinical manifestation in hemophilia patients, and also indicates the effectiveness of APCC instead of exploratory surgery for intramural hematoma. Cases of intramural hematoma of the gastrointestinal tract among hemophilia patients are also reviewed.
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Affiliation(s)
- Akira Katsumi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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