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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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Surgical outcomes in people with hemophilia A taking emicizumab prophylaxis: experience from the HAVEN 1-4 studies. Blood Adv 2022; 6:6140-6150. [PMID: 35939785 PMCID: PMC9768240 DOI: 10.1182/bloodadvances.2022007458] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 12/30/2022] Open
Abstract
Many people with hemophilia A (PwHA) undergo surgery in their lifetime, often because of complications of their disease. Emicizumab is the first bispecific monoclonal antibody prophylactic therapy for PwHA, and its efficacy and safety have been previously demonstrated; however, there is a need to build an evidence base on the management of PwHA on emicizumab undergoing surgery. Data from the HAVEN 1-4 phase 3 clinical trials were pooled to provide a summary of all minor and major surgeries in PwHA with or without factor VIII (FVIII) inhibitors who were receiving emicizumab prophylaxis. Overall, 233 surgeries were carried out during the HAVEN 1-4 trials: 215 minor surgeries (including minor dental and joint procedures, central venous access device placement or removal, and endoscopies) in 115 PwHA (64 with FVIII inhibitors) and 18 major surgeries (including arthroplasty and synovectomy) in 18 PwHA (10 with FVIII inhibitors). Perioperative hemostatic support was at the discretion of the treating physician. Overall, the median (interquartile range [IQR]) age was 33.5 (13.0-49.0) years and the median (IQR) emicizumab exposure time before surgery was 278.0 (177.0-431.0) days. Among the 215 minor surgeries, 141 (65.6%) were managed without additional prophylactic factor concentrate, and of those, 121 (85.8%) were not associated with a postoperative bleed. The majority (15 of 18 [83.3%]) of major surgeries were managed with additional prophylactic factor concentrate. Twelve (80.0%) of these 15 surgeries were associated with no intraoperative or postoperative bleeds. The data demonstrate that minor and major surgeries can be performed safely in PwHA receiving emicizumab prophylaxis. These trials are registered at www.clinicaltrials.gov as #NCT02622321, #NCT02795767, #NCT02847637, and #NCT03020160.
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Brondi S, Palareti L, Mazzetti G. Comprehensive care for haemophilia: A literature review for improving institutional cooperation. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2019.1652415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sonia Brondi
- Department of Education Studies “Giovanni Maria Bertin”, University of Bologna Bologna, Italy
| | - Laura Palareti
- Department of Education Studies “Giovanni Maria Bertin”, University of Bologna Bologna, Italy
| | - Greta Mazzetti
- Department of Education Studies “Giovanni Maria Bertin”, University of Bologna Bologna, Italy
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Escobar MA, Brewer A, Caviglia H, Forsyth A, Jimenez-Yuste V, Laudenbach L, Lobet S, McLaughlin P, Oyesiku JOO, Rodriguez-Merchan EC, Shapiro A, Solimeno LP. Recommendations on multidisciplinary management of elective surgery in people with haemophilia. Haemophilia 2018; 24:693-702. [PMID: 29944195 DOI: 10.1111/hae.13549] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/23/2022]
Abstract
Planning and undertaking elective surgery in people with haemophilia (PWH) is most effective with the involvement of a specialist and experienced multidisciplinary team (MDT) at a haemophilia treatment centre. However, despite extensive best practice guidelines for surgery in PWH, there may exist a gap between guidelines and practical application. For this consensus review, an expert multidisciplinary panel comprising surgeons, haematologists, nurses, physiotherapists and a dental expert was assembled to develop practical approaches to implement the principles of multidisciplinary management of elective surgery for PWH. Careful preoperative planning is paramount for successful elective surgery, including dental examinations, physical assessment and prehabilitation, laboratory testing and the development of haemostasis and pain management plans. A coordinator may be appointed from the MDT to ensure that critical tasks are performed and milestones met to enable surgery to proceed. At all stages, the patient and their parent/caregiver, where appropriate, should be consulted to ensure that their expectations and functional goals are realistic and can be achieved. The planning phase should ensure that surgery proceeds without incident, but the surgical team should be ready to handle unanticipated events. Similarly, the broader MDT must be made aware of events in surgery that may require postoperative plans to be changed. Postoperative rehabilitation should begin soon after surgery, with attention paid to management of haemostasis and pain. Surgery in patients with inhibitors requires even more careful preparation and should only be undertaken by an MDT experienced in this area, at a specialized haemophilia treatment centre with a comprehensive care model.
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Affiliation(s)
- M A Escobar
- McGovern Medical School and the Gulf States Hemophilia and Thrombophilia Center, University of Texas Health Science Center, Houston, TX, USA
| | - A Brewer
- Department of Oral and Maxillofacial Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - H Caviglia
- Orthopedics and Traumatology Department, "Juan A. Fernandez" Hospital, Buenos Aires, Argentina
| | - A Forsyth
- REBUILD Program/Diplomat Specialty Infusion Group, Cincinnati, OH, USA
| | - V Jimenez-Yuste
- Department of Haematology, La Paz University Hospital - IdiPaz, Madrid, Spain
| | - L Laudenbach
- London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | - S Lobet
- Haemostasis and Thrombosis Unit, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - P McLaughlin
- Haemophilia Centre and Thrombosis Unit, Royal Free Hospital, London, UK
| | - J O O Oyesiku
- Haemophilia, Haemostasis and Thrombosis Centre, Basingstoke & North Hampshire Hospital, Basingstoke, UK
| | - E C Rodriguez-Merchan
- Department of Orthopaedic Surgery, La Paz University Hospital - IdiPaz, Madrid, Spain
| | - A Shapiro
- Indiana Hemophilia & Thrombosis Center, Indianapolis, IN, USA
| | - L P Solimeno
- IRCCS Cà Granda Foundation, Maggiore Hospital of Milan, Milan, Italy
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Ty P, Menon J, Ar N, Halanaik D, Kramadhari H. Short-term clinico-radiological outcome of chronic knee synovitis among haemophilia A patients post phosphorus-32 radiosynoviorthesis. J Orthop Surg (Hong Kong) 2017; 25:2309499016684500. [PMID: 28193140 DOI: 10.1177/2309499016684500] [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: 11/16/2022] Open
Abstract
PURPOSE Various modes of therapy have been directed at breaking the vicious cycle at early stage of synovitis in haemophilia patients. This study was planned to assess the short-term clinico-radiological outcome of chronic knee synovitis among haemophilia A patients post phosphorus-32 (P-32) radiosynoviorthesis. METHODS P-32 samarium radiocolloid was injected into the knee and patients were followed up at 1 and 3 months, respectively. Clinical outcomes was assessed using Tegner Lysholm scores (TLSs), Modified Knee Society Clinical Rating System (MKSS) score and circumference of the knee joint. The radiological outcomes were assessed using X-ray, ultrasonography and bone scan. RESULTS Among the fifteen haemophilia A patients studied, there was statistically significant difference in TLS ( χ2(2) = 27.887 and p value < 0.001), MKSS scores ( χ2(2) = 27.745 and p < 0.001) and circumference of the knee joint ( χ2(2) = 21.333 and p < 0.001) at preoperatively, 1- and 3-month follow-up. There were no changes noted in follow-up X-rays compared with the preoperative X-ray. Ultrasonography showed that clinical improvement was more in suprapatellar and medial parapatellar regions in the last 2 months compared to the first month of follow-up. Post P-32 bone scan showed marked decrease in uptake in the affected knee joint suggestive of radio ablation of synovial tissue. CONCLUSION P-32 radiosynoviorthesis done for chronic synovitis among haemophilia A patients showed significant improvement in both clinical and radiological parameters. Ultrasonography can be utilized as non-invasive radiological modality for follow-up of P32 response for knee joint.
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Affiliation(s)
- Prasanna Ty
- 1 Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Jagadish Menon
- 1 Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nataraj Ar
- 2 Department of Orthopaedics, ESIC-MC & PGIMSR, Rajajinagar, Bengaluru, India
| | - Dhanapathi Halanaik
- 3 Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Harshith Kramadhari
- 4 Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Carcao M, Hilliard P, Escobar MA, Solimeno L, Mahlangu J, Santagostino E. Optimising musculoskeletal care for patients with haemophilia. Eur J Haematol 2015; 95 Suppl 81:11-21. [DOI: 10.1111/ejh.12581] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2014] [Indexed: 12/31/2022]
Affiliation(s)
- Manuel Carcao
- Division of Haematology/Oncology and Child Health Evaluative Sciences; Research Institute; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Pamela Hilliard
- Department of Rehabilitation; The Hospital for Sick Children; University of Toronto; Toronto ON Canada
| | - Miguel A. Escobar
- Gulf States Hemophilia and Thrombophilia Center; Department of Hematology; University of Texas Health Science Center; Houston TX USA
| | - Luigi Solimeno
- Ortho Trauma Unit; Emergency Department; IRCCS Cà Granda Foundation; Maggiore Hospital; Milan Italy
| | - Johnny Mahlangu
- Haemophilia Comprehensive Care Centre; Faculty of Health Sciences; University of the Witwatersrand and National Health Laboratory Service; Johannesburg South Africa
| | - Elena Santagostino
- Hemophilia and Thrombosis Center ‘A. Bianchi Bonomi’; IRCCS Cà Granda Foundation; Maggiore Hospital; Milan Italy
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Abstract
With advances in care, increasing numbers of people with hemophilia (PWH) achieve near-normal life expectancies and present with typical age-related cardiovascular conditions. Evidence-based guidelines for medical or surgical management of cardiovascular conditions in individuals with hemophilia are limited. Published recommendations exist for the management of some common cardiovascular conditions (eg, ischemic heart disease, atrial fibrillation), but identifying optimal strategies for anticoagulant or antithrombotic therapy constitutes the primary challenge of managing nonoperative cardiovascular disease (CVD) in PWH. In general, as long as factor concentrates or other hemostatic therapies maintain adequate hemostasis, the recommended medical and surgical management of CVD in PWH parallels that in individuals without hemophilia. The presence of factor inhibitors complicates hemophilia management. Published outcomes of CVD treatment in PWH are similar to those in the general population. Specific knowledge about factor replacement, factor inhibitors, and disease-specific treatment distinguishes the cardiovascular care of PWH from similar care of individuals without this rare bleeding disorder. Furthermore, a multidisciplinary approach incorporating a hematologist with an onsite coagulation laboratory, ideally associated with a hemophilia treatment center, is integral to the management of CVD in PWH.
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Caviglia H, Candela M, Landro ME, Douglas Price AL, Neme D, Galatro GA. Haemophilia pseudotumours in patients with inhibitors. Haemophilia 2015; 21:681-5. [DOI: 10.1111/hae.12632] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/29/2022]
Affiliation(s)
- H. Caviglia
- Department of Orthopaedic Surgery and Traumatology; Dr. Juan A. Fernández General Hospital; Buenos Aires Argentina
- Haemophilia Foundation; Buenos Aires Argentina
| | - M. Candela
- Haemophilia Foundation; Buenos Aires Argentina
| | - M. E. Landro
- Department of Orthopaedic Surgery and Traumatology; Dr. Juan A. Fernández General Hospital; Buenos Aires Argentina
| | - A. L. Douglas Price
- Department of Orthopaedic Surgery and Traumatology; Dr. Juan A. Fernández General Hospital; Buenos Aires Argentina
| | - D. Neme
- Haemophilia Foundation; Buenos Aires Argentina
| | - G. A. Galatro
- Department of Orthopaedic Surgery and Traumatology; Dr. Juan A. Fernández General Hospital; Buenos Aires Argentina
- Haemophilia Foundation; Buenos Aires Argentina
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Total knee arthroplasty in a patient with hypofibrinogenemia. Arthroplast Today 2015; 2:177-182. [PMID: 28326424 PMCID: PMC5247511 DOI: 10.1016/j.artd.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/25/2015] [Accepted: 10/13/2015] [Indexed: 12/20/2022] Open
Abstract
Patients with afibrinogenemia or hypofibrinogenemia present a unique challenge to the arthroplasty surgeon as fibrinogen is a key contributor to hemostasis. Patients with these disorders are known to have a higher risk for postsurgical bleeding complications. We present the case of a patient with hypofibrinogenemia who underwent an elective total knee arthroplasty. Our colleagues in hematology-oncology guided us initially to achieve and maintain appropriate fibrinogen levels in the early perioperative period. However, the patient developed an acute joint effusion and subsequent infection 4 weeks after her initial operation. Her fibrinogen levels were noted to have fallen below the target range by that time, and it was also revealed that the patient failed to follow-up with hematology-oncology to monitor her levels. Based on our review of the available literature, we recommend that patient's fibrinogen levels be closely monitored and maintained ideally >100 mg/dL not only in the initial perioperative window but perhaps for the first 4-6 weeks postoperatively as well.
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Mensah PK, Gooding R. Surgery in patients with inherited bleeding disorders. Anaesthesia 2014; 70 Suppl 1:112-20, e39-40. [DOI: 10.1111/anae.12899] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2014] [Indexed: 11/29/2022]
Affiliation(s)
- P. K. Mensah
- Haemophilia Centre; Leicester Royal Infirmary; Leicester UK
| | - R. Gooding
- Haemophilia Centre; Leicester Royal Infirmary; Leicester UK
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Zhang GF, Chai Y, Li WS, Huang LS, Shen G. Successful esophagectomy in a patient with combined esophageal cancer and hemophilia B. World J Gastroenterol 2014; 20:12701-12703. [PMID: 25253980 PMCID: PMC4168113 DOI: 10.3748/wjg.v20.i35.12701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 04/29/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
Patients with esophageal cancer often require esophagectomy with esophagogastrostomy. However, the incidence of complications, such as hemorrhage, during operations for esophageal cancer is high, even with minimally invasive surgery. Without the appropriate interventions, the risk of major intraoperative and postoperative hemorrhage is very high in patients with esophageal cancer and hemophilia. We report the case of a 45-year-old man with esophageal cancer and hemophilia B who underwent a successful hybrid, minimally invasive Ivor-Lewis esophagectomy with appropriate perioperative management.
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