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Blokzijl J, Pisters MF, Aspdahl M, de Boer W, Dybvik Matlary RE, Douma-van Riet D, de Kleijn P, Lobet S, Loughnane P, McLaughlin P, Bladen M, Roche S, Stephensen D, van Vlimmeren L, van Vulpen LFD, Timmer MA. A clinical practice guideline for primary care physiotherapy in patients with haemophilia. Haemophilia 2024. [PMID: 38987021 DOI: 10.1111/hae.15065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/30/2024] [Accepted: 05/21/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION As a result of centralisation of haemophilia care to a limited number of intramural settings, many persons with haemophilia have to travel long distances to attend their haemophilia specialised treatment centre. However, regular physiotherapy treatment can be provided by primary care physiotherapists in the person's own region. Due to the rarity of the disease most primary care physiotherapists have limited experience with this population. This study aims to provide a clinical practice guideline for primary care physiotherapists working with persons with bleeding disorders. METHOD A list of the most urgent key-questions was derived from a previous study. Literature was summarised using the grading of recommendations assessment, development, and evaluation (GRADE) evidence-to-decision framework. Recommendations were drafted based on four 90 min consensus meetings with expert physiotherapists. Recommendations were finalised after feedback and >80% consensus of all stakeholders (including PWH, physiotherapists, haematologists and the corresponding societies). RESULTS A list of 82 recommendations was formulated to support primary care physiotherapists when treating a person with a bleeding disorder. These recommendations could be divided into 13 categories: two including recommendations on organisation of care, six on therapy for adult patients with bleeding disorders and five on therapy adaptations for paediatric care. Therapy recommendations included treatment after a joint- or muscle bleed, haemophilic arthropathy, chronic synovitis, non-haemophilia related conditions and orthopaedic surgery. CONCLUSION An evidence-based practice guideline, based on current evidence from literature and clinical expertise, has been developed for primary care physiotherapists treating a person with haemophilia. To improve care, the recommendations should be implemented in daily practice.
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Affiliation(s)
- Johan Blokzijl
- Centre for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, the Netherlands
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Martijn F Pisters
- Physical Therapy Research, Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - Magnus Aspdahl
- Women's Health and Allied Health Professionals Theme, Pediatric occupational therapy and physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Wypke de Boer
- Department of Rehabilitation, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ruth Elise Dybvik Matlary
- Department of Clinical Service, Section for physiotherapy, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Piet de Kleijn
- Centre for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Sébastien Lobet
- Hemostasis and Thrombosis Unit, Division of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Neuromusculoskeletal Lab (NMSK), Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain (UCLouvain), Ottignies-Louvain-la-Neuve, Belgium
| | | | - Paul McLaughlin
- Research Department of Haematology, University College London, London, UK
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Melanie Bladen
- Haemophilia Center, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Great Ormond St, Institute of Child Health, University College London, London, UK
| | - Sheila Roche
- National Coagulation Centre, St. James's Hospital, Dublin, Ireland
| | - David Stephensen
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, UK
| | - Leo van Vlimmeren
- Department of Rehabilitation, Paediatric Physical Therapy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lize F D van Vulpen
- Centre for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Merel A Timmer
- Centre for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, the Netherlands
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Su Q, Shao Y, Bao Y, Kan Y, Wu B, Ye F. A qualitative study on the perioperative experiences and demands of haemophilic arthropathy patients undergoing total joint replacement. Haemophilia 2024; 30:1050-1058. [PMID: 38923219 DOI: 10.1111/hae.15073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/29/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Total joint replacement is the optimal treatment option for patients with severe haemophilic arthritis. Current research emphasizes patient-reported outcomes as a vital measure for evaluating surgical outcomes and patient satisfaction. Nevertheless, very limited information about the subjective experience of perioperative haemophiliacs in the literature, highlighting the need for exploration in this area. AIM To investigate the psychological experiences and health demands of haemophilic arthropathy patients during the perioperative period of total joint replacement. DESIGN Qualitative descriptive research with semistructured individual interviews. METHODS From June to September 2023, nine patients with severe haemophilic arthropathy who underwent total joint replacement at a Haemophilia Diagnosis and Treatment Centre in China were interviewed for average 37 min per person. Data were analysed using the traditional content analysis method and reported following the consolidated criteria for reporting qualitative research. The study is reported according to the COREQ checklist. RESULTS Interviews described two main themes: (1) emotional decline which involves preoperative overoptimism, early postoperative anxiety and disease uncertainty during the early independent rehabilitation. (2) wellness aspiration which includes rehabilitation support and spiritual healing. CONCLUSION This study reveals the patients' significant psychological changes and their well-being aspiration, particularly out-of-hospital rehabilitation needs. Strengthening communication between multidisciplinary teams and patients, enhancing the involvement of nurses, broadening the scope of functions at primary Haemophilia Treatment Centres, and developing telerehabilitation, these concerted efforts may improve the overall treatment experience for patients.
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Affiliation(s)
- Qian Su
- Zhejiang Chinese Medical University, School of Nursing, Hangzhou, China
| | - Yashuang Shao
- Zhejiang Chinese Medical University, School of Nursing, Hangzhou, China
| | - Yunchun Bao
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Yanan Kan
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Bainv Wu
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Fuying Ye
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
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3
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Mulders G, Uitslager N, Kavanagh M, Birkedal MF, Nicolo G, Fenton R, Westesson LM. The role of the specialist nurse in comprehensive care for bleeding disorders in Europe: An integrative review. Haemophilia 2024; 30:598-608. [PMID: 38439128 DOI: 10.1111/hae.14974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION Managing bleeding disorders (BDs) is complex, requiring a comprehensive approach coordinated by a multidisciplinary team (MDT). Haemophilia nurses (HNs) play a central role in the MDT, frequently coordinating care. As novel treatments bring change to the treatment landscape, ongoing education and development is key. However, understanding of the roles and tasks of HNs is lacking. AIM The EAHAD Nurses Committee sought to identify and describe the roles and tasks of the European HN. METHODS A five-step integrative review was undertaken, including problem identification, literature search, data evaluation, data synthesis and presentation. Relevant literature published from 2000 to 2022 was identified through database, hand and ancestry searching. Data were captured using extraction forms and thematically analysed. RESULTS Seven hundred and seventy-seven articles were identified; 43 were included. Five main roles were identified, with varied and overlapping associated tasks: Educator, Coordinator, Supporter, Treater and Researcher. Tasks related to education, coordination and support were most frequently described. Patient education was often 'nurse-led', though education and coordination roles concerned both patients and health care practitioners (HCPs), within and beyond the MDT. The HN coordinates care and facilitates communication. Long-term patient care relationships place HNs in a unique position to provide support. Guidelines for HN core competencies have been developed in some countries, but autonomy and practice vary. CONCLUSION As the treatment landscape changes, all five main HN roles will be impacted. Despite national variations, this review provides a baseline to anticipate educational needs to enable HNs to continue to fulfil their role.
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Affiliation(s)
- Greta Mulders
- Department of Hematology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nanda Uitslager
- Center for Benign Haematology, Thrombosis and Haemostasis, Van Creveldkliniek, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mary Kavanagh
- Children's Coagulation Centre, Children's Health Ireland, Dublin, Ireland
| | | | - Gabriella Nicolo
- Angelo Bianchi Bonomi Haemophilia and Trombosis Center, Milan, Italy
| | | | - Linda Myrin Westesson
- Department of Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Academy, Institution for Nursing Science and Health at Gothenburg University, Gothenburg, Sweden
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Wang J, Zhu H, Gan J, Liang G, Li L, Zhao Y. Engineered mRNA Delivery Systems for Biomedical Applications. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2308029. [PMID: 37805865 DOI: 10.1002/adma.202308029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/05/2023] [Indexed: 10/09/2023]
Abstract
Messenger RNA (mRNA)-based therapeutic strategies have shown remarkable promise in preventing and treating a staggering range of diseases. Optimizing the structure and delivery system of engineered mRNA has greatly improved its stability, immunogenicity, and protein expression levels, which has led to a wider range of uses for mRNA therapeutics. Herein, a thorough analysis of the optimization strategies used in the structure of mRNA is first provided and delivery systems are described in great detail. Furthermore, the latest advancements in biomedical engineering for mRNA technology, including its applications in combatting infectious diseases, treating cancer, providing protein replacement therapy, conducting gene editing, and more, are summarized. Lastly, a perspective on forthcoming challenges and prospects concerning the advancement of mRNA therapeutics is offered. Despite these challenges, mRNA-based therapeutics remain promising, with the potential to revolutionize disease treatment and contribute to significant advancements in the biomedical field.
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Affiliation(s)
- Ji Wang
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China
| | - Haofang Zhu
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China
| | - Jingjing Gan
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China
| | - Gaofeng Liang
- Institute of Organoids on Chips Translational Research, Henan Academy of Sciences, Zhengzhou, 450009, China
| | - Ling Li
- Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, China
| | - Yuanjin Zhao
- Department of Rheumatology and Immunology, Nanjing Drum Tower Hospital, School of Biological Science and Medical Engineering, Southeast University, Nanjing, 210096, China
- Institute of Organoids on Chips Translational Research, Henan Academy of Sciences, Zhengzhou, 450009, China
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Ramos-Petersen L, Rodríguez-Sánchez JA, Cortés-Martín J, Reinoso-Cobo A, Sánchez-García JC, Rodríguez-Blanque R, Coca JR. A Qualitative Study Exploring the Experiences and Perceptions of Patients with Hemophilia Regarding Their Health-Related Well-Being, in Salamanca. J Clin Med 2023; 12:5417. [PMID: 37629458 PMCID: PMC10455868 DOI: 10.3390/jcm12165417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/28/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023] Open
Abstract
Hemophilia is a chronic, congenital/hereditary and X-linked disease, characterized by an insufficiency of factors VIII or IX, which are necessary for blood clotting. Those affected by hemophilia often suffer from particular psychosocial problems, both in the acceptance, coping, treatment and self-management of their disease and in their family and social relationships, which are often mediated by these circumstances. The aim of this study was to explore the experiences of people with hemophilia or their family members, of in a specific region of Spain, regarding the impact of having hemophilia. Structured interviews were conducted and developed, using the studies of the World Federation of Hemophilia and Osorio-Guzmán et al. as a guide, as well as a literature review of qualitative work on hemophilia. Data were analyzed using a six-step thematic analysis. A total of 34 interviews were thematically analyzed. The results showed that three key themes emerged from the data: (1) the daily impact of having hemophilia, (2) uncertainty about the disease, (3) the role of associations and (4) support from institutions. The results make it clear that the disease has a major impact on their lives (work, family, leisure and personal environment). The main conclusion is that hemophilia has a negative impact on the daily lives of patients, families and caregivers.
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Affiliation(s)
- Laura Ramos-Petersen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain;
| | - Juan Antonio Rodríguez-Sánchez
- Department of Biomedical Sciences and Diagnosis, University of Salamanca, C/Alfonso X el Sabio S/N, 37007 Salamanca, Spain;
| | - Jonathan Cortés-Martín
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.)
| | - Andrés Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Arquitecto Francisco Peñalosa 3, Ampliación de Campus de Teatinos, 29071 Malaga, Spain;
| | - Juan Carlos Sánchez-García
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.)
| | - Raquel Rodríguez-Blanque
- Research Group CTS1068, Andalusia Research Plan, Junta de Andalucía, Nursing Department, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (J.C.-M.); (J.C.S.-G.); (R.R.-B.)
- San Cecilio Clinical University Hospital, 18016 Granada, Spain
| | - Juan R. Coca
- Social Research Unit on Health and Rare Diseases, Sociology and Social Work Department, University of Valladolid, 47002 Valladolid, Spain;
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Schutgens RE, Jimenez-Yuste V, Escobar M, Falanga A, Gigante B, Klamroth R, Lassila R, Leebeek FW, Makris M, Owaidah T, Sholzberg M, Tiede A, Werring DJ, van der Worp HB, Windyga J, Castaman G. Antithrombotic Treatment in Patients With Hemophilia: an EHA-ISTH-EAHAD-ESO Clinical Practice Guidance. Hemasphere 2023; 7:e900. [PMID: 37304933 PMCID: PMC10256340 DOI: 10.1097/hs9.0000000000000900] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/24/2023] [Indexed: 06/13/2023] Open
Abstract
Cardiovascular disease is an emerging medical issue in patients with hemophilia (PWH) and its prevalence is increasing up to 15% in PWH in the United States. Atrial fibrillation, acute and chronic coronary syndromes, venous thromboembolism, and cerebral thrombosis are frequent thrombotic or prothrombotic situations, which require a careful approach to fine-tune the delicate balance between thrombosis and hemostasis in PWH when using both procoagulant and anticoagulant treatments. Generally, PWH could be considered as being naturally anticoagulated when clotting factors are <20 IU/dL, but specific recommendations in patients with very low levels according to the different clinical situations are lacking and mainly based on the anecdotal series. For PWH with baseline clotting factor levels >20 IU/dL in need for any form of antithrombotic therapy, usually treatment without additional clotting factor prophylaxis could be used, but careful monitoring for bleeding is recommended. For antiplatelet treatment, this threshold could be lower with single-antiplatelet agent, but again factor level should be at least 20 IU/dL for dual antiplatelet treatment. In this complex growing scenario, the European Hematology Association in collaboration with the International Society on Thrombosis and Haemostasis, the European Association for Hemophilia and Allied Disorders, the European Stroke Organization, and a representative of the European Society of Cardiology Working Group on Thrombosis has produced this current guidance document to provide clinical practice recommendations for health care providers who care for PWH.
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Affiliation(s)
- Roger E.G. Schutgens
- Center for Benign Hematology, Thrombosis and Hemostasis, Van Creveldkliniek University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Victor Jimenez-Yuste
- Hematology Department, La Paz University Hospital, Autonoma University, Madrid, Spain
| | - Miguel Escobar
- University of Texas Health Science Center at Houston, TX, USA
| | - Anna Falanga
- University of Milano Bicocca, School of Medicine, Monza, Italy
- Department of Transfusion Medicine and Hematology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Bruna Gigante
- Division of Cardiovascular Medicine, Department of Medicine, Karolinska Institutet, Solna, Sweden
- Department of Clinical Science, Danderyd Hospital, Karolinska institutet, Stockholm, Sweden
| | - Robert Klamroth
- Department of Internal Medicine Angiology and Coagulation Disorders at the Vivantes Klinikum im Friedrichshain, Berlin, Germany
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Medical Faculty, University of Bonn, Germany
| | - Riitta Lassila
- Department of Hematology, Coagulation Disorders Unit, and Research Program Unit in Systems Oncology Oncosys, Medical Faculty, University of Helsinki, Finland
| | - Frank W.G. Leebeek
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Michael Makris
- Haemophilia and Thrombosis Centre, University of Sheffield, United Kingdom
| | - Tarek Owaidah
- King Faisal Specialist Hospital and Research Centre, Alfaisal University, Riyadh, Saudi Arabia
| | - Michelle Sholzberg
- Division of Hematology-Oncology, Departments of Medicine, and Laboratory Medicine and Pathobiology, St. Michael’s Hospital, Li Ka Shing Knowledge Institute, University of Toronto, Canada
| | - Andreas Tiede
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Germany
| | - David J. Werring
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, London, United Kingdom
| | | | - Jerzy Windyga
- Department of Hemostasis Disorders and Internal Medicine, Laboratory of Hemostasis and Metabolic Diseases, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy
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Montoro-Ronsano JB, Poveda-Andrés JL, Romero-Garrido JA, García-Barcenilla S, González-Álvarez I, Núñez-Vázquez R, Rambla-Pérez M, Soto-Ortega I. [Translated article] Consensus recommendations for the improvement of inter- and intra-centre care coordination in the management of hemophilia. FARMACIA HOSPITALARIA 2023; 47:T100-T105. [PMID: 37150664 DOI: 10.1016/j.farma.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 05/09/2023] Open
Abstract
OBJECTIVE Define consensus recommendations to improve care coordination between Hospital Pharmacy, Hematology and Nursing, inter- and intra-center, in the care of hemophilia patients. METHOD Recommendations for the improvement of care coordination in the management of hemophilia patients were identified and assessed by a multidisciplinary panel of professionals with experience in this field (Hospital Pharmacy, Hematology and Nursing) and supported by scientific evidence. The identified recommendations were assessed by Rand/UCLA consensus methodology (Delphi-adapted) based on their appropriateness and, subsequently, on their necessity. In both cases, it was used ordinal Likert scale. Data were statistically analyzed through different metrics. RESULTS Fifty-three recommendations for the improvement of care coordination between Hospital Pharmacy, Hematology and Nursing in the management of hemophilia patients were identified, grouped into eight areas of action: i) Hemophilia units, reference centers and multidisciplinary care; ii) Role of Hematology, Hospital Pharmacy and Nursing in the patient journey of hemophilia patients; iii) Telepharmacy and telemedicine; iv) Pharmacokinetic monitoring; v) Transition to adult patient regimen; vi) Patient health education; vii) Surgery, emergency room and hospital admission; and viii) Outcome evaluation. All recommendations were assessed as appropriate and necessary by the external expert panel. CONCLUSIONS Hemophilia patient journey is complex and depends on different variables. It also requires the involvement of different healthcare professionals who must act in a coordinated and integrated manner at all stages of the patient's life, adapted to their individual needs. On this matter, the identified and agreed recommendations may improve continuity and quality of care, as they facilitate the integration and coordination of the professionals involved in the management of this pathology, especially Hospital Pharmacy, Hematology and Nursing.
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Affiliation(s)
| | - José Luis Poveda-Andrés
- Servicio de Farmacia Hospitalaria, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Sara García-Barcenilla
- Unidad de Coagulopatías Congénitas y Adquiridas, Instituto de Investigación Hospital Universitario La Paz, IdiPAZ, Comunidad de Madrid, Spain
| | - Iria González-Álvarez
- Unidad de Hematología Clínica, Hospital de la Santa Creu i Sant Pau, Barcelona, Comunidad de Madrid, Spain
| | - Ramiro Núñez-Vázquez
- Sección de Trombosis y Hemostasia, Servicio de Hematología, Unidad de Gestión Clínica de Hematología del Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Inmaculada Soto-Ortega
- Sección de Hemostasia y Trombosis, Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias (HUCA), Laboratorio de Investigación en Plaquetas, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
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8
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Montoro-Ronsano JB, Poveda-Andrés JL, Romero-Garrido JA, García-Barcenilla S, González-Álvarez I, Núñez-Vázquez R, Rambla-Pérez M, Soto-Ortega I. Consensus recommendations for the improvement of inter- and intra-centre care coordination in the management of hemophilia. FARMACIA HOSPITALARIA 2023; 47:100-105. [PMID: 36764844 DOI: 10.1016/j.farma.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVE Define consensus recommendations to improve care coordination between Hospital Pharmacy, Haematology and Nursing, inter- and intra-center, in the care of haemophilia patients. METHOD Recommendations for the improvement of care coordination in the management of haemophilia patients were identified and assessed by a multidisciplinary panel of professionals with experience in this field (Hospital Pharmacy, Haematology and Nursing) and supported by scientific evidence. The identified recommendations were assessed by Rand/UCLA consensus methodology (Delphi-adapted) based on their appropriateness and, subsequently, on their necessity. In both cases, it was used ordinal Likert scale. Data were statistically analysed through different metrics. RESULTS Fifty-three recommendations for the improvement of care coordination between Hospital Pharmacy, Haematology and Nursing in the management of haemophilia patients were identified, grouped into eight areas of action: i) Haemophilia units, reference centers and multidisciplinary care; ii) Role of Haematology, Hospital Pharmacy and Nursing in the patient journey of haemophilia patients; iii) Telepharmacy and telemedicine; iv) Pharmacokinetic monitoring; v) Transition to adult patient regimen; vi) Patient health education; vii) Surgery, emergency room and hospital admission; and viii) Outcome evaluation. All recommendations were assessed as appropriate and necessary by the external expert panel. CONCLUSIONS Haemophilia patient journey is complex and depends on different variables. It also requires the involvement of different healthcare professionals who must act in a coordinated and integrated manner at all stages of the patient's life, adapted to their individual needs. On this matter, the identified and agreed recommendations may improve continuity and quality of care, as they facilitate the integration and coordination of the professionals involved in the management of this pathology, especially Hospital Pharmacy, Haematology and Nursing.
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Affiliation(s)
| | - José Luis Poveda-Andrés
- Servicio de Farmacia Hospitalaria, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - Sara García-Barcenilla
- Unidad de Coagulopatías Congénitas y Adquiridas, Instituto de Investigación Hospital Universitario La Paz, Madrid, España
| | - Iria González-Álvarez
- Unidad de Hematología Clínica, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - Ramiro Núñez-Vázquez
- Sección de Trombosis y Hemostasia, Servicio de Hematología, Unidad de Gestión Clínica de Hematología del Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - Inmaculada Soto-Ortega
- Sección de Hemostasia y Trombosis, Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, España; Laboratorio de Investigación en Plaquetas, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España
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9
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Rhoades R, French Z, Yang A, Walsh K, Drelich DA, McKenzie SE. Perioperative Outcomes of Patients with Bleeding Disorders Undergoing Major Surgery at an Academic Hemophilia Treatment Center. Clin Appl Thromb Hemost 2023; 29:10760296231165056. [PMID: 36972481 PMCID: PMC10052468 DOI: 10.1177/10760296231165056] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Persons with bleeding disorders (PwBD) are at high risk for bleeding with invasive procedures. However, the risk of bleeding in PwBD undergoing major surgery and outcomes of patients managed perioperatively at a hemophilia treatment center (HTC) are not well described. We performed a retrospective review of surgical outcomes among PwBD undergoing major surgery between January 1st, 2017 and December 31st, 2019 at the Cardeza Foundation Hemophilia and Thrombosis Center in Philadelphia, PA. The primary outcome was postoperative bleeding, assessed according to the ISTH-SSC's 2010 definition. Secondary outcomes included use of unplanned postoperative hemostatic therapy, LOS, and 30-day readmission rate. Results were compared to non-PwBD population from a surgical database, matched for surgery, age, and sex. During the study period, 50 PwBD underwent 63 major surgeries. The most common diagnoses were VWD (64%) and hemophilia A (20.0%). The most common surgical procedure category was orthopedic (33.3%), predominantly arthroplasties. Postoperatively,4.8% of procedures were complicated by major bleeding and 1.6% by non-major bleeding. The mean LOS was 1.65 days, and 30-day readmission rate was 1.6%. In comparison to matched, non-PwBD patients in a national surgical database undergoing the same procedures, study patients had a similar rate of bleeding complications per procedure (5.0% vs 1.04% P = .071, Fisher's exact test). PwBD undergoing major surgeries have low rates of major bleeding when receiving comprehensive care at an HTC. Bleeding and hospital readmission rates were similar to non-PwBD baseline in a large database.
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Affiliation(s)
- Ruben Rhoades
- Division of Hematology, Department of Medicine, Cardeza Foundation for Hematologic Research, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Zachary French
- Division of Hematology, Department of Medicine, Cardeza Foundation for Hematologic Research, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Amy Yang
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Douglass A Drelich
- Division of Hematology, Department of Medicine, Cardeza Foundation for Hematologic Research, 6559Thomas Jefferson University, Philadelphia, PA, USA
- CSL Behring, King of Prussia, PA, USA
| | - Steven E McKenzie
- Division of Hematology, Department of Medicine, Cardeza Foundation for Hematologic Research, 6559Thomas Jefferson University, Philadelphia, PA, USA
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10
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Seo HS, Ahn WK, Hahn SM, Han JW, Lyu CJ. Surgical Procedures Requiring Hospitalization and Perioperative Management for Patients with Hereditary Bleeding Disorders. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2022. [DOI: 10.15264/cpho.2022.29.2.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hyeun Su Seo
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Won Kee Ahn
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Seung Min Hahn
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Jung Woo Han
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Chuhl Joo Lyu
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Department of Pediatric Hemato-Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
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11
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Rodriguez-Merchan EC, De la Corte-Rodriguez H, Alvarez-Roman T, Gomez-Cardero P, Encinas-Ullan CA, Jimenez-Yuste V. Complications and Implant Survival of Total Knee Arthroplasty in People with Hemophilia. J Clin Med 2022; 11:6244. [PMID: 36362472 PMCID: PMC9658035 DOI: 10.3390/jcm11216244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/21/2022] [Accepted: 10/21/2022] [Indexed: 08/29/2023] Open
Abstract
Total knee arthroplasty (TKA) is a commonly used option in advanced stages of knee arthropathy in people with hemophilia (PWH). The objective of this article is to determine what the complication rates and implant survival rates in PWH are in the literature. A literature search was carried out in PubMed (MEDLINE), Cochrane Library, Web of Science, Embase and Google Scholar utilizing the keywords "hemophilia TKA complications" on 20 October 2022. It was found that the rate of complications after TKA in PWH is high (range 7% to 30%), although it has improved during the last two decades, possibly due to better perioperative hematologic treatment. However, prosthetic survival at 10 years has not changed substantially, being in the last 30 years approximately 80% to 90% taking as endpoint the revision for any reason. Survival at 20 years taking as endpoint the revision for any reason is 60%. It is possible that with a precise perioperative control of hemostasis in PWH, the percentage of complications after TKA can be diminished.
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Affiliation(s)
- Emerito Carlos Rodriguez-Merchan
- Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, 28046 Madrid, Spain
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research—IdiPAZ (La Paz University Hospital—Autonomous University of Madrid), 28046 Madrid, Spain
| | | | - Teresa Alvarez-Roman
- Department of Hematology, La Paz University Hospital-IdiPaz, 28046 Madrid, Spain
| | | | | | - Victor Jimenez-Yuste
- Department of Hematology, La Paz University Hospital-IdiPaz, 28046 Madrid, Spain
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12
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Scaturro D, Vitagliani F, Tomasello S, Mangano MS, Signa G, Letizia Mauro G. Postural Assessment Systems in the Prevention of Haemophilic Arthropathy: A Narrative Review. J Funct Morphol Kinesiol 2022; 7:jfmk7030068. [PMID: 36135426 PMCID: PMC9504687 DOI: 10.3390/jfmk7030068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
This narrative review aims to give an overview of some postural evaluation systems currently used in patients with haemophilia. Among them, first, we analyse the HJHS scale, recognized as a specific evaluation tool for haemophilic arthropathy. Second, we focus on other systems usually used in non-haemophilic patients that have also shown good applicability in this patient category, such as gait analysis, stabilometry, and baropodometric examination. This review underlines the use these tools could have in clinical practice to identify the early postural alterations in patients with haemophilia and set up personalised rehabilitation programs.
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Affiliation(s)
- Dalila Scaturro
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy
- Correspondence: ; Tel.: +39-3206945411
| | - Fabio Vitagliani
- Faculty of Medicine and Surgery, University of Catania, 95100 Catania, Italy
| | - Sofia Tomasello
- Faculty of Medicine and Surgery, University of Palermo, 90127 Palermo, Italy
| | | | - Gabriele Signa
- Faculty of Medicine and Surgery, University of Catania, 95100 Catania, Italy
| | - Giulia Letizia Mauro
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy
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13
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Rodriguez-Merchan EC. Past, present and future of orthopedic surgery in hemophilia: looking to a world without bleeding and arthropathy in the near future. Expert Rev Hematol 2022; 15:821-831. [PMID: 35930399 DOI: 10.1080/17474086.2022.2110063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The purpose of this article is to review the literature on orthopedic surgery in people with hemophilia (PWH), to better understand its past and present and attempt to predict the future. AREAS COVERED A Cochrane Library and PubMed (MEDLINE) search of studies related to orthopedic surgery in PWH was analyzed. A downward trend in orthopedic surgery in PWH has been observed. Patients on continuous prophylaxis are less likely to require orthopedic surgery. In patients with hemophilia, the risk of major bleeding remains high after total joint arthroplasty, even with factor replacement. Cases of acute compartment syndrome, pseudotumors and even limb amputations are still observed in PWH. EXPERT OPINION Orthopedic surgery for PWH should always be performed in specialized centers with multidisciplinary expertise in the correct management of hemophilia. It is paramount to perform an accurate preoperative coagulation screening before surgery. The availability of prophylaxis through replacement and the recent non-replacement therapy in the well-developed countries will diminish substantially or hopefully abolish completely the need for surgery in the treatment of PWH. Therefore, we are looking to a world without bleeding and arthropathy in the next future. Unfortunately, this is not true for the under-development countries.
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Affiliation(s)
- E Carlos Rodriguez-Merchan
- Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain.,Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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14
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Cho S, Perry AM, Cheng AM, Wang C, Rico JF. Advances in Hemophilia A Management. Adv Pediatr 2022; 69:133-147. [PMID: 35985706 DOI: 10.1016/j.yapd.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hemophilia A is an inherited insufficiency of Factor VIII (FVIII), one of the critical clotting factors. The gold standard for the management of moderate-to-severe hemophilia A is prophylaxis using regular replacement therapy with clotting factor concentrates. Compared with conventional treatment, extended half-life products reduce the burden of frequent factor replacement injections. Of note, up to 30% of patients with hemophilia A receiving prophylactic factor infusions develop "inhibitors," neutralizing anti-FVIII autoantibodies. Therapeutic options for patients with hemophilia A and inhibitors include the immune tolerance induction (ie, eradication of inhibitors) and the management of acute bleeds with bypassing agents and/or emicizumab. Emicizumab is a biphasic monoclonal antibody mimicking activated FVIII, approved for patients with hemophilia A with/without inhibitors. Gene therapy is an emerging therapy for hemophilia A, essentially curing patients with hemophilia A or transforming them to a milder phenotype by establishing continuous endogenous expression of FVIII after one-time treatment.
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Affiliation(s)
- Sukjoo Cho
- Division of Hematology/Oncology, Department of Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA
| | - Ashley M Perry
- Division of Hematology/Oncology, Department of Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA
| | - Anna M Cheng
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Carrie Wang
- University of South Florida Morsani College of Medicine, 560 Channelside Drive, Tampa, FL 33602, USA
| | - Juan Felipe Rico
- Division of Hematology/Oncology, Department of Pediatrics, University of South Florida Morsani College of Medicine, 2 Tampa General Circle, 5th Floor, Tampa, FL 33606, USA.
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15
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George AM, Mayya A, Mayya A, Iszham AB, Rafi NHBM, Marius R, Mayya SS. Knowledge and Awareness regarding Dental Management of Hemophilic Patients among Students of a Malaysian University: A Cross-Sectional Study. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2205260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Improper management of bleeding disorders in the dental setting can lead to complications that can endanger the lives of such patients.
Objective:
This study aimed to assess the knowledge and awareness of dental management of hemophilia among undergraduate students of a Malaysian university.
Methodology:
A cross-sectional survey was conducted in the year 2018-2019 to collect the data. A 23-item questionnaire developed and validated by the authors was used to collect data on the knowledge and awareness regarding dental management of hemophilia patients. A total of 216 dental students participated in this research. Unpaired t-test and one-way ANOVA were used to compare the knowledge score between gender and academic year.
Results:
Only 21% of the participants were confident in treating a hemophilia patient. About 97% of the participants believed that the dental curriculum must be modified to emphasize the dental management of bleeding disorders. The overall mean of the knowledge score was 47.38% and awareness was 73.7% regarding the management of patients with hemophilia.
Conclusion:
The study revealed significant scope for improvement in the dental students' knowledge, which can be achieved by modifying the dental curriculum suitably to provide more emphasis on the management of bleeding disorders.
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16
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Gillinov SM, Burroughs PJ, Moore HG, Rubin LE, Frumberg DB, Grauer JN. Total Hip Arthroplasty in Patients With Classic Hemophilia: A Matched Comparison of 90-Day Outcomes and 5-Year Implant Survival. J Arthroplasty 2022; 37:1333-1337. [PMID: 35257821 PMCID: PMC9177736 DOI: 10.1016/j.arth.2022.02.107] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients with classic hemophilia can develop joint hemarthroses, degenerative changes, and eventually require total hip arthroplasty (THA). Little data exist concerning THA outcomes in this population, and evidence-based guidelines specifically addressing venous thromboembolism (VTE) prophylaxis in this population are lacking. METHODS A retrospective study was conducted using the 2010-2020 PearlDiver MHip database. Patients undergoing primary THA were identified, and those with classic hemophilia were matched 1:10 with non-hemophilia patients based on age, gender, and Elixhauser Comorbidity Index. Ninety-day serious adverse events, minor adverse events, and any adverse events were compared with multivariate analysis. Reoperation at 5 years was assessed using Kaplan-Meier analysis. RESULTS Five hundred eighteen classic hemophilia THA patients were matched 1:10 with 5,193 non-hemophilia patients. On multivariate analysis, those with classic hemophilia had greater odds of aggregated any adverse events (odds ratio [OR] 1.76), serious adverse events (OR 2.30), and minor adverse events (OR 1.52) (P < .001 for each). Patients with classic hemophilia had greater odds of bleeding issues (transfusion, OR 1.98; hematoma, OR 4.23; P < .001 for both), VTE (deep vein thrombosis, OR 2.67; pulmonary embolism, OR 4.01; P < .001 for both), and acute kidney injury (OR 1.63; P = .03). Five-year implant survival was lower in hemophilia patients (91.9%) relative to matched controls (95.3%; P = .009). CONCLUSION Hemophilia patients undergoing THA had elevated risks of both 90-day bleeding complications (transfusion and hematoma) and VTE (deep vein thrombosis and pulmonary embolism) relative to matched controls. These findings emphasize the need to balance factor replacement and VTE prophylaxis. Although the 5-year implant survival was lower in hemophilia patients, this represented a difference of 3.4% at 5 years, suggesting that THA remains effective in this cohort.
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Affiliation(s)
| | | | | | - Lee E. Rubin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - David B. Frumberg
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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17
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Champagne PA, Bourassa M, Desjardins MP, Cloutier S, Demers C, Singbo NU, Néron H, Pelland-Marcotte MC. Post-procedural bleeding rate and haemostatic treatment use for dental procedures before and after the implementation of a standardized protocol for people with inherited bleeding disorders. Haemophilia 2022; 28:806-813. [PMID: 35751905 DOI: 10.1111/hae.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/27/2022] [Accepted: 06/08/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Persons with inherited bleeding disorders are at a substantial risk of bleeding following dental procedures. AIM To compare the outcomes and use of haemostatic treatment pre- and post-implementation of a standardized protocol for dental procedures at a Hemophilia Treatment Centre. METHODS We conducted a retrospective cohort study of outpatient and inpatient dental procedures and maxillofacial surgeries sustained by people with bleeding disorders treated at a comprehensive Hemophilia Treatment Centre (2013-2020), comparing patients' outcomes before and after the introduction of the protocol in 2018. The protocol, built using a multidisciplinary approach, suggested haemostatic treatment based on the invasiveness of the dental procedure and the proposed anaesthesia. Our primary outcome was the rate of procedural bleeding leading to medical or dental reintervention within 10 days. Secondary outcomes included the use of systemic haemostatic treatment and treatment-related adverse effects. RESULTS Overall, 137 dental procedures in 95 patients (median age: 29 years; 78% males; 74% haemophilia, 14% von Willebrand disease, 12% other disorders) were included. Seventeen procedural bleedings were reported (12.4%). Procedural bleeding occurred in 14.8% and 8.9% of patients in the control and intervention groups (p = .304). No major bleeding occurred. Tranexamic acid was used more consistently after protocol implementation (72.8% vs. 89.3%, p = .019), while factor concentrates use decreased (65.4% vs. 44.6%, p = .016), and desmopressin use remained constant (46.4% vs. 32.1%, p = .100). No treatment-related adverse effects were reported. CONCLUSION The use of a standardized protocol increased the use of tranexamic acid, with a nonstatistically significant reduction in procedural bleeding rate.
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Affiliation(s)
| | - Michelle Bourassa
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada.,Medicine and Dental Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada
| | - Marie-Pier Desjardins
- Department of Pediatrics, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada
| | - Stéphanie Cloutier
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada.,Department of Hematology, CHU de Québec, Quebec City, Quebec, Canada
| | - Christine Demers
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada.,Department of Hematology, CHU de Québec, Quebec City, Quebec, Canada
| | - Narcisse Ulrich Singbo
- Recherche Clinique et Évaluative, CHU de Québec Research Center, Quebec City, Quebec, Canada
| | - Hélène Néron
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada
| | - Marie-Claude Pelland-Marcotte
- Centre d'hémophilie de l'Est du Québec, Quebec City, Canada.,Division of Pediatric Hematology-Oncology, CHU de Québec - Centre Mère-Enfant Soleil, Quebec City, Quebec, Canada
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18
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Harrison C, Chase J, Fawcett K, Shoemark R, Valderrama Y. Into a brave new world: Haemophilia A & von Willebrand Disease Surgery with novel therapies. Haemophilia 2022; 28 Suppl 4:125-131. [PMID: 35521734 DOI: 10.1111/hae.14543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/25/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Haemophilia & von Willebrand disease are both recognised inherited bleeding disorders. With increased access to highly efficient and safe replacement and novel therapies, management of surgical interventions in this group can be safely managed by experienced multidisciplinary teams. AIM To review the evidence for managing surgery in the era of novel therapies. METHOD We explore four cases and establish the role of the clinical nurse specialist within the surgical pathway. RESULTS All of these cases evidence the continued important role of both the multidisciplinary planning prior to any surgical interventions in people with bleeding disorders and the key role of the Nurse Specialist in ensuring this plan is then implemented. Key focuses of communication with all parties involved in the patient journey, performing education for the patient, family and wider healthcare team about the underlying bleeding disorder and the importance of time critical medicines being given on time is essential. CONCLUSION These cases demonstrate that individuals with bleeding disorders are at risk of developing other rare conditions alongside their life long condition, in addition to comorbidities associated with ageing. Evidence for rare plus rare is likely to be minimal as demonstrated within the cases, and recognition of how to reach out to international peers in the field is important. Sharing complex case management at national & international meetings and in publication has never been so important.
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Affiliation(s)
- Catherine Harrison
- Sheffield Haemophilia & Thrombosis Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, England
| | - Jaime Chase
- John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | | | - Robyn Shoemark
- Haemophilia Treatment Centre, The Children's Hospital, Westmead, New South Wales, Australia
| | - Yadira Valderrama
- Comprehensive Haemophilia Treatment Center of Colsubidio Children's Clinic, Colombia
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19
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Kleiboer B, Layer MA, Cafuir LA, Cuker A, Escobar M, Eyster ME, Kraut E, Leavitt AD, Lentz SR, Quon D, Ragni MV, Thornhill D, Wang M, Key NS, Buckner TW. Postoperative bleeding complications in patients with hemophilia undergoing major orthopedic surgery: A prospective multicenter observational study. J Thromb Haemost 2022; 20:857-865. [PMID: 35080347 PMCID: PMC8940712 DOI: 10.1111/jth.15654] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Persons with hemophilia (PWH) are at risk for chronic hemophilic arthropathy (HA). Joint replacement surgery may be used to relieve intractable pain and/or restore joint function. OBJECTIVES This multicenter, prospective, observational cohort study evaluated the rate of bleeding during the postoperative period after total hip (THA) or knee arthroplasty (TKA). PATIENTS/METHODS We included PWH of any severity ≥18 years of age who were undergoing THA or TKA. Clinical decisions were made at the discretion of the treating physician according to local standards of care. Clinical data were prospectively recorded. Major bleeding was defined as bleeding in a critical site, bleeding that resulted in either a 2 g/dl or greater decrease in hemoglobin during any 24-h period, or transfusion of two or more units of packed red blood cells. RESULTS One hundred thirty-one procedures (98 TKA and 33 THA) were performed, 39 (29.8%) of which were complicated by major bleeding, including 46% of THA and 25% of TKA. The risk of major bleeding was increased in THA compared to TKA (OR 2.50, p = .05), and by the presence of an inhibitor (OR 4.29, p = .04), increased BMI (OR 4.49 and 6.09 for overweight and obese, respectively, compared to normal BMI, each p < .01), and non-use of an antifibrinolytic medication (OR 3.00, p = .03). Neither continuous clotting factor infusion (versus bolus infusion) nor pharmacologic thromboprophylaxis were associated with bleeding risk. CONCLUSIONS The bleeding risk remains substantial after THA and TKA in PWH, despite factor replacement. Use of antifibrinolytic medications is associated with decreased risk.
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Affiliation(s)
- Brendan Kleiboer
- Department of Medicine and UNC Blood Research Center, University of North Carolina
| | - Marcus A. Layer
- Department of Medicine and UNC Blood Research Center, University of North Carolina
| | | | - Adam Cuker
- Department of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Miguel Escobar
- McGovern Medical School, University of Texas Health Science Center at Houston
| | | | - Eric Kraut
- The Ohio State University Hemostasis and Thrombosis Center
| | - Andrew D. Leavitt
- Department of Laboratory Medicine and Department of Internal Medicine, University of California San Francisco
| | - Steven R. Lentz
- Department of Internal Medicine, University of Iowa Carver College of Medicine
| | - Doris Quon
- Orthopaedic Hemophilia Treatment Center, Orthopaedic Institute for Children
| | - Margaret V. Ragni
- Department of Medicine and Clinical and Translational Science, University of Pittsburgh School of Medicine
| | | | | | - Nigel S. Key
- Department of Medicine and UNC Blood Research Center, University of North Carolina
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20
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Abed H, Alsahafi E. People with congenital bleeding disorders perspectives on why dentists refused to treat them: An exploratory qualitative study using a card sorting technique. SPECIAL CARE IN DENTISTRY 2022; 42:575-584. [PMID: 35279861 DOI: 10.1111/scd.12713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Abstract
AIMS This qualitative study aimed to assess people with congenital bleeding disorders (CBDs) perspectives on why their dentists refused to treat them. METHODS Using validated and reliable questions, people with CBDs were asked about their attitude toward dental visit and teeth brushing, perceived thought about dentists' knowledge and skill in treating them, perceived dental anxiety, and perceived barriers toward receiving dental services. Free text responses were added to report reasons of why people with CBDs could not brush their teeth sometimes and why the dentists refused to treat them. An open card sorting method was used to analyze participants free text reports. RESULTS A total of 30 participants were recruited for the purpose of this qualitative study (70% adults and 30% children). Hemophilia A affected the majority of both groups. The majority of participants (n = 20, 67%) reported that they have been refused to be treated by their dentists (71% of adults versus 56% of children, as reported by their parents, p-value = 0.398). Adult participants reported that they have been refused to be treated by dentists due to fear of dentists from uncontrolled gingival bleeding, their dentists' beliefs that no dental treatment required for them, their thoughts that their dentists will refuse to treat them and difficulty of accommodating the dental visit with other medical appointments. Parents of children reported other reasons such as parents did not ask for dental treatments, difficulty of dental treatment to dentists, young age of patient, and poor accessibility to dental services due to long waiting list. Fear of adult participants from uncontrolled gingival bleeding (n = 4, 57%) and poor compliance of children toward teeth brushing (n = 2, 29%) were the reasons behind why they could not brush their teeth sometimes. CONCLUSIONS Among several reported reasons, fear of dentists from uncontrolled gingival bleeding was the most reported reason of why dentists refused to treat adults with CBDs. While other reasons were reported by parents of children with CBDs such as parents did not ask for dental treatment to their children, difficulty of dental treatment to dentists, young age of patients, and poor accessibility due to long waiting list.
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Affiliation(s)
- Hassan Abed
- Division of Diagnostic Oral Medicine, Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Elham Alsahafi
- Division of Oral Biology, Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia
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21
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St-Louis J, Chowdary P, Dolan G, Goodyear D, Strike K, Pollard D, Teitel J. Multidisciplinary Team Care of Patients with Hemophilic Arthropathy: A Qualitative Assessment of Contemporary Practice in the UK and Canada. Clin Appl Thromb Hemost 2022; 28:10760296211070002. [PMID: 35060765 PMCID: PMC8796082 DOI: 10.1177/10760296211070002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We used a structured interview to explore approaches to comprehensive hemophilia and arthropathy care among 24 healthcare professionals (HCPs) from multidisciplinary teams (MDTs) in Canada and the UK. Represented MDTs typically comprise a hematologist, nurse, physiotherapist, and sometimes an orthopedic surgeon; pediatric (and some adult) MDTs also include a social worker/psychologist. HCPs emphasized the centrality of a team approach, facilitated through MDT meetings and involvement of all MDT members in patient care. In both countries, nurses and physiotherapists play critical, multifaceted roles. Respondents agreed that MDTs are crucial for successful transitioning, which can be facilitated by close collaboration between pediatric and adult MDTs, even when they are not co-located. Physiotherapists are instrumental in providing non-pharmacological pain relief. Hematologists or physiotherapists typically make orthopedic referrals, with the nurse, physiotherapist and hematologist working together in patient preparation for (and follow-up after) surgery. MDT best practices include a non-hierarchical team approach, ensuring that all MDT members know all patients, and regular MDT meetings. Together, these real-life insights from the MDT perspective emphasize the value of the MDT approach in comprehensive hemophilia care.
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Affiliation(s)
| | | | - Gerry Dolan
- Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Karen Strike
- Hamilton Niagara Regional Hemophilia Treatment Centre, McMaster Children's Hospital, McMaster University, Hamilton, Canada
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22
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Rodriguez-Merchan EC, De la Corte-Rodriguez H, Alvarez-Roman T, Gomez-Cardero P, Encinas-Ullan CA, Jimenez-Yuste V. Total knee arthroplasty in hemophilia: lessons learned and projections of what's next for hemophilic knee joint health. Expert Rev Hematol 2022; 15:65-82. [PMID: 35041571 DOI: 10.1080/17474086.2022.2030218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The purpose of this article has been to review the literature on total knee arthroplasty (TKA) in people with hemophilia (PWH), to mention the lessons we have learned from our own experience and to try to find out what the future of this type of surgery will be. AREAS COVERED A Cochrane Library and PubMed (MEDLINE) search of studies related to TKA PWH was analyzed. In PWH, the complication rate after TKA can be up to 31.5%. These include infection (7.1%) and bleeding in the form of hematoma, hemarthrosis or popliteal artery injury (8.9%). In a meta-analysis the revision arthroplasty rate was 6.3%. One-stage or two-stage revision arthroplasty due to infection (septic loosening) is not always successful despite providing correct treatment (both hematological and surgical). In fact, the risk of prosthetic re-infection is about 10%. It is necessary to perform a re-revision arthroplasty, which is a high-risk and technically difficult surgery that can sometimes end in knee arthrodesis or above-the-knee amputation of the limb. EXPERT OPINION TKA (both primary and revision) should be performed in centers specialized in orthopedic surgery and rehabilitation (knee) and hematology (hemophilia), and with optimal coordination between the medical team.
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Affiliation(s)
- E Carlos Rodriguez-Merchan
- Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid, Spain.,Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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McLaughlin P, Holland M, Dodgson S, Khair K. Project GYM: A randomized feasibility study investigating effect on motivation of personal trainer-led exercise in young men with hemophilia. Res Pract Thromb Haemost 2021; 5:e12613. [PMID: 34870067 PMCID: PMC8626598 DOI: 10.1002/rth2.12613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/08/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Many young men with hemophilia engage in physical activity and sport but face challenges to participation because of their hemophilia. Project GYM aimed to investigate the feasibility of a hemophilia-specific fitness program led by a personal trainer (PT) and its impact on gym activity, motivation, and adherence to exercise. METHODS This was a nonblinded, randomized feasibility study, recruiting participants aged 18 to 25 years with hemophilia A or B (all severities, ± inhibitor) from three London hemophilia centers. All participants were given an activity tracker and free gym membership. Participants were randomized to a "gym only" or "gym and PT" arm. Participants completed questionnaires evaluating motivation to exercise, quality of life, physical activity levels, self-efficacy, and self-esteem at study start and study end. RESULTS Of 142 eligible individuals, 19 agreed to participate. Participants were healthy, with mean body mass index and adiposity slightly lower than the UK average. They reported low bleed numbers and had good joint health (median Hemophilia Joint Health Score [HJHS], 0; range, 0-13). The gym and PT group had more gym attendance than the gym-only group. Seven participants increased their activity levels and nine stayed the same, with no statistical difference between groups. HJHS scores improved in 3 participants and were unchanged in 12. There was no bleeding associated with gym activity. CONCLUSION Project GYM has demonstrated the safety and feasibility of a tailored physical training program in young men with hemophilia. Increased gym attendance, with and without support from a PT, is associated with increased physical activity.
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Affiliation(s)
- Paul McLaughlin
- Katharine Dormandy Haemophilia Centre and Thrombosis UnitRoyal Free London NHS Foundation TrustLondonUK
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Hampton K, Tiede A, Shivamurthy S, Chowdary P. Clinical outcomes after joint surgery in patients on turoctocog alfa pegol (N8-GP) prophylaxis: A post hoc analysis. Haemophilia 2021; 28:158-165. [PMID: 34811856 DOI: 10.1111/hae.14460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Joint damage in haemophilia often requires surgical correction. However, the surgery effect on bleeding rates and other clinical joint outcomes can be unclear. AIM To investigate the effects of joint surgery on joint annualized bleeding rates (JABRs) and physical health outcomes in patients with haemophilia A undergoing N8-GP prophylaxis. METHODS Patients in the pathfinder 2 trial received N8-GP prophylaxis, enrolling in the pathfinder 3 trial for indicated surgery. Patients returned to pathfinder 2 post-surgery, continuing N8-GP prophylaxis until end-of-trial. JABRs were calculated from bleeding across all joints for pre-surgery (immediately before surgery) and post-surgery (to pathfinder 2 study end) periods. Joint-health-related outcomes were derived from patient records. RESULTS Data (41 joint surgeries; n = 30) were analysed statistically using datamining and descriptively. Pre-surgery mean JABR was higher in patients who later were operated than in 146 non-operated patients (p = .004). In operated patients, mean JABR decreased from 1.33 pre-surgery to .37 post-surgery (p = .011). In all but three patients, JABR improved or remained the same post-surgery. In the three patients whose JABR remained at one (all with multiple joint arthropathy), post-surgery bleeds were mostly at non-operated sites. Two of the three patients whose JABR increased post-surgery had undergone surgery for reasons unlikely to improve JABR. Mobility parameters often improved in patients whose JABR remained at zero. CONCLUSION Patients with haemophilia treated with N8-GP prophylaxis benefit from surgeries. However, this analysis could not differentiate the relative contributions of surgical interventions and prophylactic treatment to the improvement of JABR.
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Affiliation(s)
- Kingsley Hampton
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
| | - Andreas Tiede
- Department of Haematology, Haemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hanover, Germany
| | | | - Pratima Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
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Valentino LA, Baker JR, Butler R, Escobar M, Frick N, Karp S, Koulianos K, Lattimore S, Nugent D, Pugliese JN, Recht M, Reding MT, Rice M, Thibodeaux CB, Skinner M. Integrated Hemophilia Patient Care via a National Network of Care Centers in the United States: A Model for Rare Coagulation Disorders. J Blood Med 2021; 12:897-911. [PMID: 34707421 PMCID: PMC8544265 DOI: 10.2147/jbm.s325031] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/15/2021] [Indexed: 01/19/2023] Open
Abstract
Rare, chronic diseases such as hemophilia and other congenital coagulation disorders require coordinated delivery of services for optimal outcomes. Hemophilia Treatment Centers (HTCs) are specialized, multidisciplinary health-care centers providing team-based care to meet the physical, psychosocial, and emotional needs of people with hemophilia (PWH) and may serve as a model for other rare coagulation disorders. Health-care purchasers, as well as the general medical community, may not appreciate the breadth and quality of services provided by HTCs. They exemplify the acculturalization and actualization of integrated care by providing comprehensive diagnostic and treatment services that reduce morbidity, mortality, avoidable emergency room visits, hospitalizations, and overall costs, while promoting a longer lifespan and improved patient functioning and outcomes. This is accomplished by a team-based approach relying upon a shared decision-making model to effectively prevent complications and manage symptoms in PWH, who are dependent on high-cost treatments. This article provides a concise yet comprehensive description of the core components of an HTC and the regional and national networks in the United States, which together achieve their incomparable value for all stakeholders.
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Affiliation(s)
- Leonard A Valentino
- National Hemophilia Foundation, New York, NY, USA
- Departments of Internal Medicine and Pediatrics, Rush University, Chicago, IL, USA
| | | | - Regina Butler
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Miguel Escobar
- Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Neil Frick
- National Hemophilia Foundation, New York, NY, USA
| | - Susan Karp
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Susan Lattimore
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| | - Diane Nugent
- Center for Inherited Blood Disorders, Orange, CA, USA
| | | | - Michael Recht
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
- American Thrombosis and Hemostasis Network, Rochester, NY, USA
| | - Mark T Reding
- Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA
| | | | - Constance B Thibodeaux
- Departments of Internal Medicine and Pediatrics, Hemophilia Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mark Skinner
- Institute for Policy Advancement Ltd, Washington, DC, USA
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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O'Donovan M, Singleton E, Roche S, McGowan M, Benson J, Bergin C, Bird R, Byrne M, Duggan C, Gilmore R, Ryan K, Dougall A, O'Donnell JS, O'Connell NM. Single centre, real-world experience of perioperative rFIXFc use in adult patients with haemophilia B undergoing major and minor surgery. Haemophilia 2021; 27:e690-e697. [PMID: 34614282 DOI: 10.1111/hae.14426] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/27/2021] [Accepted: 09/20/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Recombinant factor IX fusion protein concentrate (rFIXFc) is increasingly used for prophylaxis in people with haemophilia B (PWHB), but experience in the perioperative setting is limited. AIMS To evaluate real-world perioperative factor usage, bleeding and complications in PWHB (≥18 years) who received rFIXFc for surgical haemostasis and to describe the treatment regimens used. METHODS Single centre, retrospective review of all PWHB who underwent a major or minor surgical procedure between June 2017 and July 2020 and received rFIXFc perioperatively for maintenance of surgical haemostasis. RESULTS A total of 56 PWHB (45 male and 11 female), including people with mild (n = 32), moderate (n = 4) and severe (n = 20) haemophilia B, underwent 11 major and 131 minor procedures with rFIXFc for surgical haemostasis. Haemostasis was rated as excellent (9/11) or good (2/11) in all major procedures. Median total rFIXFc consumption for orthopaedic surgeries was 972 IU/kg (range 812-1031 IU/kg) and for other major (non-orthopaedic) surgeries was 323 IU/kg (range 167-760 IU/kg). The median number of perioperative rFIXFc infusions was 19 (range 17-26) for orthopaedic surgery and 7 (range 5-17) for other major surgeries. The number of infusions in the postoperative period was determined by procedure and patient factors. Complications included bowel ileus and wound infection. Most minor procedures were managed with single infusion of rFIXFc, with no bleeding complications in 95% of minor procedures. There were no thromboembolic events or inhibitor formation. CONCLUSION This unique data provides real-world evidence that rFIXFc is safe and effective in achieving haemostasis in PWHB undergoing surgery.
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Affiliation(s)
- Mairead O'Donovan
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Evelyn Singleton
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Sheila Roche
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Mark McGowan
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Julie Benson
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Catherine Bergin
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Rachel Bird
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Mary Byrne
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | | | | | - Kevin Ryan
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Alison Dougall
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
- School of Dental Science, Trinity College Dublin, Dublin, Ireland
| | | | - Niamh M O'Connell
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
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Escobar M, Luck J, Averianov Y, Ducore J, Fernández MFL, Giermasz A, Hart DP, Journeycake J, Kessler C, Leissinger C, Mahlangu J, Martinez LV, Miesbach W, Mitha IH, Quon D, Reding MT, Schved JF, Stasyshyn O, Vilchevska KV, Wang M, Windyga J, Alexander WA, Al-Sabbagh A, Bonzo D, Mitchell IS, Wilkinson TA, Hermans C. PERSEPT 3: A phase 3 clinical trial to evaluate the haemostatic efficacy of eptacog beta (recombinant human FVIIa) in perioperative care in subjects with haemophilia A or B with inhibitors. Haemophilia 2021; 27:911-920. [PMID: 34614267 PMCID: PMC9292306 DOI: 10.1111/hae.14418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/17/2021] [Accepted: 09/06/2021] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Surgical procedures in persons with haemophilia A or B with inhibitors (PwHABI) require the use of bypassing agents (BPA) and carry a high risk of complications. Historically, only two BPAs have been available; these are reported to have variable responses. AIM To prospectively evaluate the efficacy and safety of a new bypassing agent, human recombinant factor VIIa (eptacog beta) in elective surgical procedures in PwHABI in a phase 3 clinical trial, PERSEPT 3. METHODS Subjects were administered 200 µg/kg (major procedures) or 75 µg/kg eptacog beta (minor procedures) immediately prior to the initial surgical incision; subsequent 75 µg/kg doses were administered to achieve postoperative haemostasis and wound healing. Efficacy was assessed on a 4-point haemostatic scale during the intra- and postoperative periods. Anti-drug antibodies, thrombotic events and changes in clinical/laboratory parameters were monitored throughout the perioperative period. RESULTS Twelve subjects underwent six major and six minor procedures. The primary efficacy endpoint success proportion was 100% (95% CI: 47.8%-100%) for minor procedures and 66.7% (95% CI: 22.3%-95.7%) for major procedures; 81.8% (95% CI: 48.2%-97.7%) of the procedures were considered successful using eptacog beta. There was one death due to bleeding from a nonsurgical site; this was assessed as unlikely related to eptacog beta. No thrombotic events or anti-eptacog beta antibodies were reported. CONCLUSION Two eptacog beta dosing regimens in PwHABI undergoing major and minor surgical procedures were well-tolerated, and the majority of procedures were successful based on surgeon/investigator assessments. Eptacog beta offers clinicians a new potential therapeutic option for procedures in PwHABI.
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Affiliation(s)
- Miguel Escobar
- Gulf States Hemophilia and Thrombophilia Center, Houston, Texas, USA
| | - James Luck
- Orthopaedic Hemophilia Treatment Center, Los Angeles, California, USA
| | - Yevhenii Averianov
- City Research and Development Center for Diagnostics and Treatment of Patients with Abnormal Hemostasis, Kyiv, Ukraine
| | - Jonathan Ducore
- Hematology/Oncology Clinic, University of California at Davis, Sacramento, California, USA
| | | | - Adam Giermasz
- Division of Hematology/Oncology, University of California at Davis, Sacramento, California, USA
| | - Daniel P Hart
- The Royal London Hospital Haemophilia Centre, Barts and The London School of Medicine and Dentistry, QMUL, London, UK
| | - Janna Journeycake
- Oklahoma Center for Bleeding and Clotting Disorders, Oklahoma City, Oklahoma, USA
| | - Craig Kessler
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Cindy Leissinger
- Section of Hematology/Oncology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Johnny Mahlangu
- Hemophilia Comprehensive Care Center, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | | | | | | | - Doris Quon
- Orthopaedic Hemophilia Treatment Center, Los Angeles, California, USA
| | - Mark T Reding
- Center for Bleeding and Clotting Disorders, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Jean-François Schved
- Haemophilia Treatment Centre, University Hospital Montpellier, Montpellier, France
| | | | | | - Michael Wang
- Hemophilia and Thrombosis Center, University of Colorado, Aurora, Colorado, USA
| | - Jerzy Windyga
- Department of Hemostasis Disorders and Internal Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | | | | | | | | | - Cédric Hermans
- Cliniques Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Karatas C, Alim A, Tirnova I, Demir B, Kanmaz T. Patient With Hemophilia A Undergoing Consecutive Coronary Bypass and Live Donor Liver Transplantation: A Case Report. Transplant Proc 2021; 53:2564-2566. [PMID: 34531070 DOI: 10.1016/j.transproceed.2021.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/07/2021] [Indexed: 11/17/2022]
Abstract
Liver transplantation surgery due to cirrhosis in patients with hemophilia is rare and there are limited cases in the literature. We present a case of a patient with hemophilia A who underwent 2 consecutive surgeries owing to coronary artery disease and cryptogenic cirrhosis with hepatocellular carcinoma. After these surgeries, no bleeding or other complications were seen, and the factor VIII levels have not changed since liver transplantation in the follow-up.
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Affiliation(s)
- Cihan Karatas
- Department of Organ Transplantation, Koc University Hospital, Istanbul, Turkey.
| | - Altan Alim
- Department of Organ Transplantation, Koc University Hospital, Istanbul, Turkey
| | - Ismail Tirnova
- Department of Organ Transplantation, Koc University Hospital, Istanbul, Turkey
| | - Barış Demir
- Department of Organ Transplantation, Koc University Hospital, Istanbul, Turkey
| | - Turan Kanmaz
- Department of Organ Transplantation, Koc University Hospital, Istanbul, Turkey
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Young JR, Vignaly L, O'Connor CM, Czajka CM, Rosenbaum AJ. Perioperative Management of Orthopaedic Patients with Hematologic Disorders: A Critical Analysis Review. JBJS Rev 2021; 8:e0001. [PMID: 32487975 DOI: 10.2106/jbjs.rvw.20.00001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Perioperative management of orthopaedic patients with a hematologic disorder is a complex endeavor that requires a multidisciplinary team-based approach. A team composed of an experienced orthopaedic surgeon, an anesthesiologist, and a hematologist is necessary to achieve optimal outcomes. Patients with hemophilia and other complex hematologic disorders should be managed at, or in consultation with a hematologist at, a comprehensive hemophilia center. Bleeding disorders and inherited thrombophilia present unique challenges for the perioperative management of orthopaedic surgery. Comprehensive preoperative planning and familiarity with treatment guidelines can help to minimize these risks.
Knowledge of the disease processes outlined in this article will provide orthopaedic surgeons with the requisite background knowledge that is needed to initiate safe and effective treatment strategies involving this high-risk patient population.
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Affiliation(s)
- Joseph R Young
- Division of Orthopedic Surgery, Albany Medical Center, Albany, New York
| | - Lauren Vignaly
- Division of Orthopedic Surgery, Albany Medical Center, Albany, New York
| | - Casey M O'Connor
- Division of Orthopedic Surgery, Albany Medical Center, Albany, New York
| | - Cory M Czajka
- Division of Orthopedic Surgery, Albany Medical Center, Albany, New York
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Jiménez‐Yuste V, Rodríguez‐Merchán EC, Matsushita T, Holme PA. Concomitant use of bypassing agents with emicizumab for people with haemophilia A and inhibitors undergoing surgery. Haemophilia 2021; 27:519-530. [PMID: 33988293 PMCID: PMC8359827 DOI: 10.1111/hae.14322] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Surgery in people with haemophilia and factor VIII inhibitors is typically managed with perioperative administration of haemostatic agents to prevent or control the occurrence of bleeding events. Practical experience of surgery in patients with inhibitors who are receiving treatment with emicizumab is growing; however, the novelty of the situation means that standardised guidelines are lacking with regard to the concomitant administration of haemostatic agents, including dose and laboratory monitoring. AIM To review approaches to haemostatic management during major and minor invasive procedures in patients with haemophilia A and inhibitors, and to provide recommendations for controlling bleeding events. METHODS A search was conducted, limited to the past 4 years (January 2016-April 2020), pertaining to published evidence of surgery for patients receiving emicizumab. Publications identified from the search were manually reviewed to determine studies and case reports relevant for inclusion. RESULTS Identified literature and practical experience of the authors were used to build a consensus of practical recommendations for the concomitant administration of haemostatic agents during the perioperative period for elective surgery in patients with inhibitors who are receiving emicizumab. CONCLUSIONS The current evidence base indicates that surgery can be successfully performed in patients with inhibitors who are receiving emicizumab and that bypassing agents can be used concomitantly. Data from prospective studies are required to further support recommendations for haemostatic management of surgery in patients receiving emicizumab.
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Affiliation(s)
- Victor Jiménez‐Yuste
- Department of HematologyLa Paz University Hospital‐IdiPaz, Autónoma UniversityMadridSpain
| | | | | | - Pål Andrè Holme
- Department of HematologyOslo University HospitalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
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Rodriguez-Merchan EC. Management of musculoskeletal complications in patients with hemophilia: literature review and expert recommendations. Cardiovasc Hematol Disord Drug Targets 2021; 21:162-166. [PMID: 33906595 DOI: 10.2174/1871529x21666210427134232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/02/2021] [Accepted: 03/01/2021] [Indexed: 11/22/2022]
Abstract
In people with hemophilia, hematological prophylaxis during childhood and adolescence could elude the occurrence of musculoskeletal complications (in joints and muscles) if the concentration of the defective factor is averted from decreasing under 1% of normal. Prompt management is of capital significance as the juvenile skeleton is hypersensitive to the adverse events of the disease; intense structural defects might appear rapidly. Important articular bleeds and inveterate hypertrophy of the articular synovial membrane must be treated vigorously to preclude joint degeneration (hemophilic arthropathy). At the moment that extreme joint disease is in place with intense affliction, the goal must be to reestablish activity whilst at the same time reducing the peril to the patient. Articular debridement is an efficacious surgical technique to accomplish this goal, particularly around the knee or ankle, and may be contemplated to be a backup to ankle arthrodesis or ankle or knee replacement in patients of younger age. Eventually joint replacement can commonly reestablish both articular mobility and function in an unhealthy articulation.
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Affiliation(s)
- E Carlos Rodriguez-Merchan
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid. Spain
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Camelo RM, Duarte BP, do Nascimento AM, Vanderlei AM. Third-degree atrioventricular block and pacemaker implantation in a man with severe hemophilia A: A case report. J Arrhythm 2021; 37:460-461. [PMID: 33850593 PMCID: PMC8021993 DOI: 10.1002/joa3.12513] [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] [Received: 10/30/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 11/26/2022] Open
Abstract
Hemophilia A (HA) is a rare bleeding disorder characterized by reduced factor VIII (FVIII) activity and consequently spontaneous bleeding. Since the introduction of prophylaxis with safer FVIII concentrates, people with HA are ageing. Interestingly, they are developing cardiovascular diseases as their non-hemophilia counterparts. We describe a 48-year-old patient with severe HA who presented a third-degree atrioventricular block. A DDDR pacemaker was implanted under supervision of the Hematology Clinics. There were no adverse events during the procedure. The procedure was safe, and it should be performed under the supervision of a hemophilia expert.
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Affiliation(s)
- Ricardo Mesquita Camelo
- Fundação de Hematologia e Hemoterapia de Pernambuco (HEMOPE)RecifeBrazil
- Faculty of MedicineUniversidade Federal de Minas GeraisBelo HorizonteBrazil
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Kocher F, Seeber A, Kerschbaumer J, Schmidt S, Wolf D, Feistritzer C. Case report: successful perioperative management of patients with haemophilia A using an extended half-life factor VIII (Efmoroctocog alfa) during neurosurgical procedures. Ther Adv Hematol 2021; 12:2040620721993686. [PMID: 33868623 PMCID: PMC8020741 DOI: 10.1177/2040620721993686] [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] [Received: 10/15/2020] [Accepted: 01/14/2021] [Indexed: 11/17/2022] Open
Abstract
Patients with haemophilia A (HA) undergoing neurosurgical procedures have a high risk of haemorrhage with potential fatal outcome. Here, we present a successful perioperative haemostatic concept applying an extended half-life factor VIII (EHL FVIII), Efmoroctocog alfa, in two patients with HA undergoing neurosurgery for paramedian right-sided disc herniation (case 1) and astrocytoma (case 2). After adequate EHL FVIII treatment the surgical procedures were performed without any bleeding complications despite the high-risk interventions. Laboratory measurements confirmed stable FVIII levels throughout the hospital stay. We suggest close interdisciplinary collaboration between involved clinicians as mandatory prerequisite for an optimized perioperative management in patients with HA. The presented cases indicate, that the increased stability, safety and fewer injections provide a rationale to use EHL FVIII products in HA patients undergoing surgical interventions with a very high bleeding risk.
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Affiliation(s)
- Florian Kocher
- Department of Internal Medicine V, Hematology & Oncology, Medical University of Innsbruck, Austria
| | - Andreas Seeber
- Department of Internal Medicine V, Hematology & Oncology, Medical University of Innsbruck, Austria
| | | | - Stefan Schmidt
- Department of Internal Medicine V, Hematology & Oncology, Medical University of Innsbruck, Austria
| | - Dominik Wolf
- Department of Internal Medicine V, Hematology & Oncology, Medical University of Innsbruck, Austria
| | - Clemens Feistritzer
- Department of Internal Medicine V, Hematology & Oncology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck, Tyrol 6020, Austria
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Bacci C, Cerrato A, Zanette G, Pasca S, Zanon E. Regenerative Surgery with Dental Implant Rehabilitation in a Haemophiliac Patient. TH OPEN 2021; 5:e104-e106. [PMID: 33748659 PMCID: PMC7964252 DOI: 10.1055/s-0041-1722866] [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] [Received: 11/11/2020] [Accepted: 12/16/2020] [Indexed: 10/27/2022] Open
Abstract
This study aimed to describe the first case of regenerative surgery in haemophiliac implant. Patients with haemophilia often present dental problems. A multidisciplinary approach is suggested in case of dental surgeries to reduce the high bleeding risk. A 41-year-old male patient with mild haemophilia A (FVIII 8.4%), presenting previous epistaxis, noncomplicated tooth extractions and traumatic haemartroses, all treated with single infusions of coagulation factor concentrates, was referred to the dental clinic of the Padua University Hospital based on the recommendation of his attending dentist. At first dental visit the patient reported intense pain in the right lower second molar, with impaired chewing function. After an endodontic unsuccessful treatment the element was judged as no longer recoverable. In agreement with the patient the dental element was then extracted, after a combined administration of recombinant factor VIII 3000 IU (35 IU/kg), and tranexamic acid 1,000 mg. The extraction was performed under local anaesthesia, paraperiosteal and truncular, moderate sedation, elevation of an envelope flap. After extraction, a preservation of the alveolus was carried out with bovine matrix bone graft covered with a resorbable membrane. Three months after the surgery a flapless implant was placed after a single infusion of factor VIII 2000 IU, tranexamic acid 1,000 mg, and a local para-periostal anaesthesia, without any complication. Oral surgeon and haematologist expert in coagulation diseases must therefore collaborate together to define a shared protocol for managing surgery in those patients.
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Affiliation(s)
- Christian Bacci
- Section of Dentistry, Department of Neurosciences, University of Padua, Padua, Italy
| | - Alessia Cerrato
- Section of Dentistry, Department of Neurosciences, University of Padua, Padua, Italy
| | - Gastone Zanette
- Section of Dentistry, Department of Neurosciences, University of Padua, Padua, Italy
| | - Samantha Pasca
- Department of Cardiac Thoracic and Vascular Sciences, Haemophilia Centre Unit of Coagulopathies, University Hospital of Padua, Padua, Italy
| | - Ezio Zanon
- Department of Cardiac Thoracic and Vascular Sciences, Haemophilia Centre Unit of Coagulopathies, University Hospital of Padua, Padua, Italy
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de Azevedo Kinalski M, Brondani LP, de Mattos Carpena ALM, Dos Santos MBF. Delayed bleeding in a hemophilic patient after sinus floor elevation and multiple implant placements. J ORAL IMPLANTOL 2021; 48:133-138. [PMID: 33690855 DOI: 10.1563/aaid-joi-d-20-00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Not required for clinical case letters.
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Affiliation(s)
- Mateus de Azevedo Kinalski
- Graduate student, Graduate Program Prosthodontics, School of Dentistry, Federal University of Pelotas (UFPEL), Pelotas, RS, Brazil
| | - Lucas Pradebon Brondani
- Graduate student, Graduate Program Prosthodontics, School of Dentistry, Federal University of Pelotas (UFPEL), Pelotas, RS, Brazil
| | | | - Mateus Bertolini Fernandes Dos Santos
- Universidade Federal de Pelotas Assistant Professor Graduate Program 457 Gonçalves Chaves BRAZIL Pelotas Rio Grande do Sul 96015560 Universidade Federal de Pelotas
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Rodríguez-Merchán EC. Recent advances in surgery and its perioperative treatment in people with hemophilia. Expert Rev Hematol 2021; 14:271-280. [PMID: 33605827 DOI: 10.1080/17474086.2021.1893689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: People with hemophilia (PWH) may require some surgical procedures (orthopedic surgery, cardiac surgery, neurosurgery, et cetera) throughout their lives.Areas covered: Articles on surgery and hemophilia published during the year 2020 were analyzed. The principal inclusion factor was a focal point on surgery in hemophilia. Articles that did not concentrate on this subject were not included.Expert opinion: Turoctocog alfa pegol appears to be efficacious for perioperative hemostatic treatment of all kind of surgical operations (minor and major) in PWH A. Long-acting recombinant coagulation factor IX (FIX) albumin fusion protein (rIX-FP) seems to facilitate perioperative management in PWH B. In people suffering from von Willebrand disease (VWD), the utilization of concentrates of von Willebrand factor (VWF) is commonly used for the decrease of exaggerated bleeding during surgical operations. On-demand management with 30-60 IU/kg may keep hemostasis under control during all kind of surgical operations. Factor concentrates with extended half-life (EHL) are a good option to standard half-life (SHL) products in PWH undergoing surgery, permitting diminished number of infusions and inferior consuming, particularly for EHL factor IX (FIX). Supplementary factor VIII (FVIII) and/or bypassing management have demonstrated to be secure and efficacious in association with emicizumab for major surgical procedures.
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Affiliation(s)
- E Carlos Rodríguez-Merchán
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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Malhan S, Öksüz E, Antmen B, Ar MC, Balkan C, Kavaklı K. Cost of hemophilia A in Turkey: an economic disease burden analysis. J Med Econ 2021; 24:1052-1059. [PMID: 34355649 DOI: 10.1080/13696998.2021.1965388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Hemophilia A is the second most common bleeding disorder causing patients to have lifelong follow-up and treatment. Despite being a rare disease, hemophilia A has a high economic burden on individuals and the public. The purpose of this study was to estimate the total disease cost of hemophilia A in Turkey. MATERIALS AND METHODS Data used in this analysis were collected through literature review, including studies conducted in Turkey in December 2018. A disease burden analysis was performed by modeling hemophilia A-related costs among patients, their relatives, and the social security system. Two expert panels were held to evaluate real-world data sources and to provide further information. All direct medical and non-medical costs were calculated annually from the Social Security Institution of the Republic of Turkey perspective, while indirect costs were estimated from the patient and community perspective. RESULTS For the calendar year of 2018, the number of hemophilia A patients in Turkey were estimated to be 5,055, with an average weight of 64.7 kg. The average annual direct medical, direct non-medical, and indirect costs of hemophilia A were calculated as €93,268 ($109,286; ₺502,717), €2,533 ($2,968; ₺13,655), and €7,957 ($9,323; ₺42,888) per patient, respectively, with a total annual cost of €103,759 ($121,578; ₺559,259). For the management of patients with inhibitors (4.9%), the average annual total cost was calculated to be €325,439 ($381,330; ₺1,754,117) per patient. The total annual disease burden of hemophilia A in 2018 was estimated to be about €524 million ($614 million; ₺2.82 billion), which corresponded to 1.6% of the total health expenditure in Turkey. CONCLUSION The most important reason hemophilia A has a significant economic burden in Turkey is that replacement therapy is expensive. The major cost contributor was identified as factor replacement therapy. With inhibitor development, the average annual cost increased more than 3-fold.
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Affiliation(s)
- Simten Malhan
- Faculty of Health Sciences, Department of Health Care Management, Başkent University, Ankara, Turkey
| | - Ergün Öksüz
- Department of Family Medicine, Başkent University School of Medicine, Ankara, Turkey
| | - Bülent Antmen
- Acibadem Hospital, Department of Pediatric Hematology and Oncology, Hemophilia Center, Adana, Turkey
| | - Muhlis Cem Ar
- Department of Internal Medicine, Division of Hematology, Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Can Balkan
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Ege University, Izmir, Turkey
| | - Kaan Kavaklı
- Faculty of Medicine, Department of Pediatrics, Division of Pediatric Hematology, Ege University, Izmir, Turkey
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De la Corte-Rodriguez H, Alvarez-Roman MT, Rodriguez-Merchan EC, Jimenez-Yuste V. What COVID-19 can mean for people with hemophilia beyond the infection risk. Expert Rev Hematol 2020; 13:1073-1079. [PMID: 32862729 DOI: 10.1080/17474086.2020.1818066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic represents an unprecedented global health crisis. To combat its effects, many governments have opted for strategies of social isolation that involve a radical change in people's behavior. AREAS COVERED For patients with hemophilia, the negative consequences of these measures can be greater, given they modify aspects of health care and lifestyles needed to counteract the adverse effects of hemophilia. The long-term consequences of the pandemic on patients with hemophilia are not well known. The aim of this special report is to show what COVID-19 could mean for this population, beyond the risk of infection. EXPERT OPINION Considerations of the clinical, care, therapeutic, physical, nutritional, mental health, pain, and disability aspects that might be affected are included. Strategies are also suggested to minimize the effects that these issues can have on patients' lives. Patients, health professionals, and society as a whole must work together to mitigate the effects of the pandemic on people with hemophilia.
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Swaminathan N, Thatcher C, Staber JM. Haemostatic efficacy of single-dose factor administration in neonates with severe haemophilia undergoing circumcision. Haemophilia 2020; 26:786-792. [PMID: 32746496 DOI: 10.1111/hae.14122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/09/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Perioperative management of children with haemophilia undergoing surgery is a complex and understudied topic. Circumcision is the most common procedure performed in the neonatal period, and guidelines to prevent bleeding complications from circumcision are lacking. Treatment protocols vary widely, and many centres treat patients with factor products for up to two weeks after circumcision. There is an unmet need for studies evaluating optimal factor replacement therapy around the time of circumcision in neonates with severe haemophilia. AIM To determine the efficacy of a single dose of factor replacement before circumcision to prevent bleeding complications in neonates with severe haemophilia. METHODS We conducted a retrospective chart review of male infants born between January 2000 and June 2019. Male neonates with severe haemophilia diagnosed at the Iowa Hemophilia and Thrombosis Center (n = 22) and healthy newborn controls who underwent circumcision at the University of Iowa Hospitals were included. Data were collected from the electronic medical record. Neonates with severe haemophilia were separated into two groups-those pretreated with one dose of factor replacement before circumcision and those without pretreatment. RESULTS We observed that neonates with severe haemophilia pretreated with a single dose of factor VIII or factor IX replacement had significantly reduced bleeding complications, shorter hospital stay and required less therapeutic intervention compared with untreated patients. Importantly, pretreated patients had outcomes similar to healthy controls. CONCLUSIONS Our results demonstrate that a single dose of factor replacement before circumcision is effective to prevent bleeding in neonates with severe haemophilia.
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Affiliation(s)
- Neeraja Swaminathan
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Collin Thatcher
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Janice M Staber
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA.,Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Ono K, Takedani H. Risk of deep venous thrombosis after total knee arthroplasty in patients with haemophilia A. Haemophilia 2020; 26:867-872. [DOI: 10.1111/hae.14095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/06/2020] [Accepted: 06/11/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Kumiko Ono
- Department of Joint Surgery Research Hospital The Institute of Medical Science The University of Tokyo Tokyo Japan
| | - Hideyuki Takedani
- Department of Joint Surgery Research Hospital The Institute of Medical Science The University of Tokyo Tokyo Japan
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Guelcher CJ, Chase J, Pollard D. Women and girls with heavy menstrual bleeding and inherited bleeding disorders: A call to action for the Haemophilia Treatment Centre Nurse. Haemophilia 2020; 27 Suppl 3:82-86. [PMID: 32469119 DOI: 10.1111/hae.14019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/09/2020] [Indexed: 12/27/2022]
Abstract
Over the last several decades, the increasing focus on women with inherited bleeding disorders (WBD) has brought more patients into Haemophilia Treatment Centres (HTC) around the world. These women present with unique challenges including a significant risk of heavy menstrual bleeding (HMB). The influx of a new patient group has necessitated expansion of the services provided by the multi-disciplinary team in HTCs. Nurses already play a central role in patient and family education within the HTC. As such, they are well positioned to participate in the development of adaptations within the HTC infrastructure to provide clinical care and education specifically for WBD. The nursing experts in HTCs should play an active role in outreach as well as providing education to WBD. Despite this supposition, review of the growing body of literature surrounding the topic of WBD is notable for a paucity of literature highlighting the role of the HTC nurse and potential impact on this, relatively new, but steadily increasing, patient population.
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Affiliation(s)
| | - Jaime Chase
- John Hunter Children's Hospital, New Lambton Heights, NSW, Australia
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Krzowski B, Balsam P, Peller M, Lodziński P, Grabowski M, Drozd-Sokołowska J, Basak G, Gawałko M, Opolski G, Kosiuk J. Electrophysiological Procedures in Patients With Coagulation Disorders - A Systemic Review. Circ J 2020; 84:875-882. [PMID: 32350233 DOI: 10.1253/circj.cj-20-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Catheter ablation (CA) is considered first-line treatment for many patients with symptomatic arrhythmias. Indications for CA are constantly increasing, as is the number of procedures. Although CA is nowadays regarded a safe procedure, there is a risk of complications, including both bleeding- and thrombosis-related events. Several factors contribute to periprocedural risk; of these, patient coagulation status is of considerable clinical relevance. In this context, even a simple procedure poses a considerable challenge in a patient with coagulation disorder. However, the level of evidence regarding CA in patients with coagulation disorders is very low. Neither experts' recommendations nor clinical guidelines have been presented so far. The aim of this article is to analyze potential procedure-related risks and provide clinicians with useful information and practical suggestions regarding optimization of procedural safety in patients with coagulation disorders.
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Affiliation(s)
- Bartosz Krzowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Paweł Balsam
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Michał Peller
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Piotr Lodziński
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | | | - Grzegorz Basak
- Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw
| | - Monika Gawałko
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Jedrzej Kosiuk
- 1st Chair and Department of Cardiology, Medical University of Warsaw.,Department of Electrophysiology, Helios Klinikum Koethen
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Chen CY, Tran DM, Cavedon A, Cai X, Rajendran R, Lyle MJ, Martini PGV, Miao CH. Treatment of Hemophilia A Using Factor VIII Messenger RNA Lipid Nanoparticles. MOLECULAR THERAPY. NUCLEIC ACIDS 2020; 20:534-544. [PMID: 32330871 PMCID: PMC7178004 DOI: 10.1016/j.omtn.2020.03.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/23/2020] [Accepted: 03/30/2020] [Indexed: 12/17/2022]
Abstract
Hemophilia A (HemA) patients are currently treated with costly and inconvenient replacement therapy of short-lived factor VIII (FVIII) protein. Development of lipid nanoparticle (LNP)-encapsulated mRNA encoding FVIII can change this paradigm. LNP technology constitutes a biocompatible and scalable system to efficiently package and deliver mRNA to the target site. Mice intravenously infused with the luciferase mRNA LNPs showed luminescence signals predominantly in the liver 4 h after injection. Repeated injections of LNPs did not induce elevation of liver transaminases. We next injected LNPs carrying mRNAs encoding different variants of human FVIII (F8 LNPs) into HemA mice. A single injection of B domain-deleted F8 LNPs using different dosing regimens achieved a wide range of therapeutic activities rapidly, which can be beneficial for various usages in hemophilia treatment. The expression slowly declined yet remained above therapeutic levels up to 5–7 days post-injection. Furthermore, routine repeated injections of F8 LNPs in immunodeficient mice produced consistent expression of FVIII over time. In conclusion, F8 LNP treatment produced rapid and prolonged duration of FVIII expression that could be applied to prophylactic treatment and potentially various other treatment options. Our study showed potential for a safe and effective platform of new mRNA therapies for HemA.
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Affiliation(s)
- Chun-Yu Chen
- Seattle Children's Research Institute, Seattle, WA, USA
| | | | | | - Xiaohe Cai
- Seattle Children's Research Institute, Seattle, WA, USA
| | | | - Meghan J Lyle
- Seattle Children's Research Institute, Seattle, WA, USA
| | | | - Carol H Miao
- Seattle Children's Research Institute, Seattle, WA, USA; Department of Pediatrics, University of Washington, Seattle, WA, USA.
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Curtin J, Santagostino E, Karim FA, Li Y, Seifert W, Négrier C. Simplifying surgery in haemophilia B: Low factor IX consumption and infrequent infusions in surgical procedures with rIX-FP. Thromb Res 2020; 188:85-89. [DOI: 10.1016/j.thromres.2020.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/07/2020] [Accepted: 02/13/2020] [Indexed: 11/26/2022]
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Boban A, Hermans C. An evaluation of the safety and efficacy of turoctocog alfa for hemophilia A. Expert Rev Hematol 2020; 13:303-311. [PMID: 32153219 DOI: 10.1080/17474086.2020.1740586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Hemophilia A is an inherited disorder that is characterized by decreased or absent factor (F)VIII and an increased risk of bleeding. Clinical presentation of the severe form of the disease includes spontaneous bleeding into the joints and muscles, while patients with milder forms usually exhibit trauma-associated bleeding. The treatment of hemophilia aims to prevent bleeding. A number of clotting FVIII concentrates are available for managing hemophilia A, which have different safety and efficacy characteristics. Advancements in biotechnology have enabled development of recombinant factor concentrates, which thus minimize the risk of transmitting infectious diseases. Turoctocog alfa (NovoEight®, Novo Nordisk A/S, Bagsvaerd, Denmark) was the first third-generation B-domain truncated recombinant FVIII.Areas covered: The manuscript describes the characteristics of turoctocog alfa, as well as its efficacy and safety for prophylaxis and on-demand treatment for patients with severe hemophilia A without inhibitors.Expert opinion: In clinical trials, turoctocog alfa has demonstrated very good efficacy and safety for the prophylaxis and on-demand treatment of hemophilia A patients, as well as high hemostatic activity during surgery and in managing bleeding episodes. Post-marketing studies and real-life data are anticipated to further reinforce the value of long-term prophylaxis, and estimate the incidence of inhibitors to FVIII.
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Affiliation(s)
- Ana Boban
- Department Of Internal Medicine, Division Of Hematology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Cedric Hermans
- Division of Haematology, Haemostasis and Thrombosis Unit, Cliniques Universitaires Saint- Luc, Université Catholique De Louvain, Brussels, Belgium
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Forsyth A, Blamey G, Lobet S, McLaughlin P. Practical Guidance for Non-Specialist Physical Therapists Managing People with Hemophilia and Musculoskeletal Complications. Health (London) 2020. [DOI: 10.4236/health.2020.122014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Santagostino E, Lalezari S, Reding MT, Ducore J, Ng HJ, Poulsen LH, Michaels LA, Linardi CC. Safety and efficacy of BAY 94-9027, an extended-half-life factor VIII, during surgery in patients with severe hemophilia A: Results of the PROTECT VIII clinical trial. Thromb Res 2019; 183:13-19. [DOI: 10.1016/j.thromres.2019.08.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/24/2019] [Accepted: 08/24/2019] [Indexed: 10/26/2022]
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Craddock Lee SJ, Reimer T, Garcia S, Williams EL, West M, Stuart T, Gerber DE. Definition and Coordination of Roles and Responsibilities Among Cancer Center Clinic and Research Personnel. JCO Oncol Pract 2019; 16:e64-e74. [PMID: 31589544 DOI: 10.1200/jop.19.00315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Effective enrollment and treatment of patients in cancer clinical trials require definition and coordination of roles and responsibilities among clinic and research personnel. MATERIALS AND METHODS We developed a survey that incorporated modified components of the Survey of Physician Attitudes Regarding the Care of Cancer Survivors. Surveys were administered to clinic nursing staff and research personnel at a National Cancer Institute-designated comprehensive cancer center. Results were analyzed using χ2-tests, t tests, and analyses of variance. RESULTS Surveys were completed by 105 staff members (n = 50 research staff, n = 55 clinic staff; 61% response rate). Research staff were more likely to feel that they had the skills to answer questions, convey information, and provide education for patients on trials (all P < .05). Both clinic and research staff reported receipt of communication about responsibilities in fewer than 30% of cases, although research staff reported provision of such information in more than 60% of cases. Among 20 tasks related to care of patients in trials, no single preferred model of responsibility assignment was selected by the majority of clinic staff for nine tasks (45%) or by research staff for three tasks (15%). Uncertainty about which team coordinates care was reported by three times as many clinic staff as research staff (P = .01). There was also substantial variation in the preferred model for delivery of care to patients in trials (P < .05). CONCLUSION Knowledge, attitudes, and perception of care and responsibilities for patients on clinical trials differ between and among clinic and research personnel. Additional research about how these findings affect efficiency and quality of care on clinical trials is needed.
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Affiliation(s)
| | | | - Sandra Garcia
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Mary West
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Tobi Stuart
- University of Texas Southwestern Medical Center, Dallas, TX
| | - David E Gerber
- University of Texas Southwestern Medical Center, Dallas, TX
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Abstract
The musculoskeletal problems of haemophilic patients begin in infancy when minor injuries lead to haemarthroses and haematomas. Early continuous haematological primary prophylaxis by means of the intravenous infusion of the deficient coagulation factor (ideally from cradle to grave) is of paramount importance because the immature skeleton is very sensitive to the complications of haemophilia: severe structural deficiencies may develop quickly. If primary haematological prophylaxis is not feasible due to expense or lack of venous access, joint bleeding will occur. Then, the orthopaedic surgeon must aggressively treat haemarthrosis (joint aspiration under factor coverage) to prevent progression to synovitis (that will require early radiosynovectomy or arthroscopic synovectomy), recurrent joint bleeds, and ultimately end-stage osteoarthritis (haemophilic arthropathy). Between the second and fourth decades, many haemophilic patients develop articular destruction. At this stage the main possible treatments include arthroscopic joint debridement (knee, ankle), articular fusion (ankle) and total joint arthroplasty (knee, hip, ankle, elbow).
Cite this article: EFORT Open Rev 2019;4:165-173. DOI: 10.1302/2058-5241.4.180090
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Laino L, Cicciù M, Fiorillo L, Crimi S, Bianchi A, Amoroso G, Monte IP, Herford AS, Cervino G. Surgical Risk on Patients with Coagulopathies: Guidelines on Hemophiliac Patients for Oro-Maxillofacial Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1386. [PMID: 30999657 PMCID: PMC6518229 DOI: 10.3390/ijerph16081386] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 03/29/2019] [Accepted: 04/10/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Haemophilia is a disease of genetic origin, which causes a defect in blood coagulation. Under normal conditions, in the case of leakage from the blood vessels, the blood forms a clot that reduces or blocks the bleeding. This process involves the activation of several plasma proteins in a cascade-like species. Two of these proteins, produced in the liver, factor VIII and factor IX, are deficient or present a functional defect in people with haemophilia. Because of this deficit, the haemophiliacs easily suffer external and internal bleeding. Surgical treatment of these patients is to be observed, and often their treatment is delayed due to unclear guidelines and risks in treating these patients. The aim is to provide clear guidelines in the case of surgical treatment of these patients. METHODS In this study, we have considered all the guidelines that refer to the gold-maxillofacial surgery, focusing on the literature of the last 10 years. RESULTS Surely, this collection of guidelines will favor the choice of the clinician towards safer and predictable protocols. This study does not want to create a guideline but evaluates the literature of the last 10 years, and highlights the latest for the treatment of these patients., with the aim of informing the pathology and at the same time making the surgical maneuvers safer. CONCLUSIONS Despite the research of literature has produced few results, it was nevertheless possible to draw up a guideline thanks to additional information extrapolated from textbooks and other scientific articles. According to the guidelines, it is possible to proceed to the treatment of these patients, if with appropriate therapy in a safe and risk-free manner.
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Affiliation(s)
- Luigi Laino
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", 80100 Napoli, Italy.
| | - Marco Cicciù
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, Messina University, 98100 Messina, Italy.
| | - Luca Fiorillo
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", 80100 Napoli, Italy.
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, Messina University, 98100 Messina, Italy.
| | - Salvatore Crimi
- Department of Biomedical and Surgical and Biomedical Sciences Catania University, 95125 Catania, Italy.
| | - Alberto Bianchi
- Department of Biomedical and Surgical and Biomedical Sciences Catania University, 95125 Catania, Italy.
| | - Giulia Amoroso
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, Messina University, 98100 Messina, Italy.
| | - Ines Paola Monte
- Department of General Surgery and Medical-Surgery Specialties, University of Catania, 95125 Catania, Italy.
- Department of Cardio-Thorax-Vascular and Transplant, A.O.U. Policlinico Catania, 95125 Catania, Italy.
| | - Alan Scott Herford
- Department of Maxillofacial Surgery, Loma Linda University, Loma Linda, CA 92350, USA.
| | - Gabriele Cervino
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, Messina University, 98100 Messina, Italy.
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