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Meijon-Ortigueira MDM, Alvarez-Roman MT, De La Corte H, Butta N, Jimenez-Yuste V. Predicting joint involvement through tailored prophylaxis in severe haemophilia A, is it possible? Haemophilia 2024. [PMID: 38575526 DOI: 10.1111/hae.15014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/12/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Tailored prophylaxis is the current treatment regimen for patients with severe haemophilia A. Recently, published guidelines describe two possible approaches, based on clinical characteristics or estimation of pharmacokinetic parameters. However, both have strengths and weaknesses, and their characteristics need to be integrated to optimize treatment appropriately. In this paper, we present a model that considers together the characteristics of prophylaxis and the relevance of each. METHODS The age at initiation of prophylaxis, number of bleeding events, treatment regimen, therapeutic adherence, FVIII trough levels, and joint status were analyzed in 59 patients followed at La Paz University Hospital between January 2000 and December 2019. RESULTS The mean duration of primary prophylaxis of 113.37 ± 57.79 months. Eighty-three percent (n = 49) had no joint status involvement at the end of follow-up (HJHS and HEAD-US = 0). The median ABR was 0.7 (IQR 0.2 -1.0) and 54.2% presented trough levels of FVIII during follow-up >1 IU/dL. 72,9% engaged in some type of physical activity and overall adherence was over 85% in all patients evaluated. The regression analysis performed, considering all these factors, showed that the initiation of prophylaxis before 21 months of age was the most relevant protective factor against the appearance of joint involvement (OR 88.33 p.031 CI 95% 1.49-5224.40) CONCLUSION: Early initiation of prophylaxis was the most relevant factor in the protection of joint status. More comprehensive analysis models adapted to the characteristics of each population, are needed to adequately individualize treatment.
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Affiliation(s)
| | | | - Hortensia De La Corte
- Department of Physical Medicine and Rehabilitation, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | - Nora Butta
- Department of Hematology, La Paz University Hospital-IdiPAZ, Madrid, Spain
| | - Victor Jimenez-Yuste
- Department of Hematology, La Paz University Hospital-IdiPAZ, Autonomous University of Madrid, Madrid, Spain
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Castaman G, Jimenez-Yuste V, Gouw S, D'Oiron R. Outcomes and outcome measures. Haemophilia 2024; 30 Suppl 3:112-119. [PMID: 38504408 DOI: 10.1111/hae.14990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Advances in haemophilia treatment have resulted in a near-normal life expectancy, lower burden of bleeding and treatment, and improved quality of life in high-income countries. Bleeding rate is approaching zero and novel parameters should be evaluated to assess the efficacy of treatment not only from the clinical point of view by using new methodologies (e.g. joint health assessment), but also from the patient's perspective (e.g. pain, quality of life, treatment satisfaction). METHODS AND RESULTS This approach should be aimed at combining objective clinical methodologies and patient-reported outcomes (PROs). However, some instruments used for assessing PROs are still suboptimal and not properly validated. Recent evidence suggests that these tools can take advantage from a more personalized designed approach and could be effectively improved and serve to facilitate the patient's self-evaluation. For other congenital bleeding disorders (BDs), a set of patient-relevant outcomes has been also defined that overlap substantially those of haemophilia, including bleeding, side effects and complications, and PROs, such as pain, physical functioning, impact on daily life including school and work and mental health. There is a growing focus on addressing women-specific outcomes in BDs, reflecting an increased awareness of the unique challenges faced by women in this context. However, the development of tailored tools is imperative to further advance the progress in managing women with BDs, ensuring more accurate monitoring and personalized care. CONCLUSIONS How incorporating these outcome measures in the process of approval of novel treatments for these disorders by regulatory authorities remains to be established.
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Affiliation(s)
- Giancarlo Castaman
- Center for Bleeding Disorders and Coagulation, Department of Oncology, Careggi University Hospital, Florence, Italy
| | | | - Samanta Gouw
- Department of Paediatric Haematology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roseline D'Oiron
- Bicêtre Hospital AP-HP, University of Paris-Saclay and UMR_S1176 INSERM, Le Kremlin-Bicêtre, Paris, France
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Miesbach W, Boban A, Chowdary P, Coppens M, Crato M, Jimenez-Yuste V, Klamroth R, Makris M, Mulders G, Peyvandi F. Administration of gene therapy for haemophilia - The hub and spoke model and its regional differences and challenges. Haemophilia 2024. [PMID: 38500258 DOI: 10.1111/hae.14985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/27/2024] [Accepted: 02/27/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Wolfgang Miesbach
- Medical Clinic 2, Institute of Transfusion Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Ana Boban
- Haemophilia Centre, Department of Haematology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Michiel Coppens
- Hemophilia Treatment Center, Department of Vascular Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Pulmonary Hypertension & Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Miguel Crato
- European Haemopilia Consortium, Brussels, Belgium
| | - Victor Jimenez-Yuste
- Hematology Department, Hospital Universitario La Paz-IdiPaz, Autonoma University, Madrid, Spain
| | - Robert Klamroth
- Department for Internal Medicine and Vascular Medicine, Haemophilia Treatment Center, Vivantes Hospital im Friedrichshain, Berlin, Germany
| | - Mike Makris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Greta Mulders
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Miesbach W, Boban A, Chowdary P, Coppens M, Crato M, Jimenez-Yuste V, Klamroth R, Makris M, Mulders G, Peyvandi F. EAHAD haemophilia gene therapy clinical outcome database (EAHAD-GTD). Haemophilia 2024. [PMID: 38462796 DOI: 10.1111/hae.14981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Wolfgang Miesbach
- Medical Clinic 2, Institute of Transfusion Medicine, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ana Boban
- Department of Haematology, Haemophilia Centre, University Hospital Centre Zagreb, Zagreb, Croatia
- Haemophilia Centre, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Michiel Coppens
- Department of Vascular Medicine, Hemophilia Treatment Center, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension & Thrombosis, Amsterdam, The Netherlands
| | - Miguel Crato
- European Haemopilia Consortium, Brussels, Belgium
| | - Victor Jimenez-Yuste
- Hematology Department, Hospital Universitario La Paz-IdiPaz, Autonoma University, Madrid, Spain
| | - Robert Klamroth
- Department for Internal Medicine and Vascular Medicine, Haemophilia Treatment Center, Vivantes Hospital im Friedrichshain, Berlin, Germany
| | - Mike Makris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Greta Mulders
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Rodriguez-Merchan EC, De la Corte-Rodriguez H, Gomez-Cardero P, Alvarez-Roman MT, Jimenez-Yuste V. Arthroscopic ankle surgery in people with haemophilia. Haemophilia 2024; 30:286-294. [PMID: 38379188 DOI: 10.1111/hae.14967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION People with haemophilia (PWH) not administered primary haematological prophylaxis since childhood, that is, those treated haematologically on demand or not treated at all, often experience the degeneration of the ankles, leading to pain and functional impairment. AIM To analyse the outcomes and complications of arthroscopic ankle surgery performed on PWH. METHODS For this narrative review of the literature, a search was conducted in PubMed on 2, December 2023, using the keywords "haemophilia", "ankle" and "arthroscopy". Of the 29 articles identified, 15 specifically related to ankle arthroscopy in PWH were selected (inclusion criterion). The remaining articles did not meet this requirement (exclusion criterion) and were therefore eliminated. RESULTS Arthroscopic procedures (arthroscopic synovectomy, debridement and arthrodesis of the ankle) are increasingly used in the surgical treatment of haemophilic ankle arthropathy. Although arthroscopic ankle surgery offers good outcomes in patients with haemophilia, the procedure is not free of complications, which range from 7.9% for arthroscopic ankle debridement to 13.1% in arthroscopic ankle synovectomy and 17.8% in arthroscopic ankle arthrodesis, respectively. The non-union rate of arthroscopic ankle arthrodesis is 7.1% (2/28). CONCLUSION Although arthroscopic interventions in the haemophilic ankle (synovectomy, debridement, arthrodesis) offer good functional outcomes, they are associated with a non-negligible rate of complications. Arthroscopic ankle surgery in PWH is major surgery and should be treated as such.
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Affiliation(s)
- E Carlos Rodriguez-Merchan
- Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain
- Osteoarticular Surgery Research, La Paz Hospital Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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Miesbach W, Carcao M, Mahlangu J, Dargaud Y, Jimenez-Yuste V, Hermans C. Eptacog beta for the management of patients with haemophilia A and B with inhibitors: A European perspective. Haemophilia 2024; 30:257-266. [PMID: 38317441 DOI: 10.1111/hae.14944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/25/2023] [Accepted: 10/20/2023] [Indexed: 02/07/2024]
Abstract
Eptacog beta (activated), a recombinant human factor VIIa (rFVIIa), was approved by the US Food and Drug Administration (FDA) in 2020 (SEVENFACT®, LFB & HEMA Biologics) and the European Medicines Agency (EMA) in 2022 (CEVENFACTA®, LFB). In Europe, eptacog beta is indicated for the treatment of bleeds and the prevention of bleeds during surgery or invasive procedures in adults and adolescents (≥12 years old) with congenital haemophilia A or B with high-titre inhibitors (≥5 BU) or with low-titre inhibitors who are expected to have a high anamnestic response to factor VIII or factor IX, or to be refractory to increased dosing of these factors. The efficacy and safety of eptacog beta were evaluated in three Phase III clinical studies, PERSEPT 1, 2 and 3. For the EMA filing dossier, the analysis of data from PERSEPT 1 and 2 differed from the analysis used to support the filing in the US. In this review, we summarise current data regarding the mode of action, clinical efficacy and safety of eptacog beta for the management of haemophilia A and B in patients with inhibitors from a European perspective. In addition to providing a valuable summary of the analyses of the clinical data for eptacog beta conducted for the EMA, our review summarises the potential differentiators for eptacog beta compared with other current bypassing agents.
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Affiliation(s)
- Wolfgang Miesbach
- Department of Haemostaseology and Hemophilia Center, Medical Clinic 2, Institute of Transfusion Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Manuel Carcao
- The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Johnny Mahlangu
- Haemophilia Comprehensive Care Centre, Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Yesim Dargaud
- Clinical Haemostasis Unit and Lyon Haemophilia Centre, Louis Pradel Hospital, Lyon, France
| | | | - Cédric Hermans
- Haemostasis and Thrombosis Unit, Division of Haematology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium
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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: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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von Drygalski A, Chowdary P, Kulkarni R, Susen S, Konkle BA, Oldenburg J, Matino D, Klamroth R, Weyand AC, Jimenez-Yuste V, Nogami K, Poloskey S, Winding B, Willemze A, Knobe K. Efanesoctocog Alfa Prophylaxis for Patients with Severe Hemophilia A. N Engl J Med 2023; 388:310-318. [PMID: 36720133 DOI: 10.1056/nejmoa2209226] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Efanesoctocog alfa provides high sustained factor VIII activity by overcoming the von Willebrand factor-imposed half-life ceiling. The efficacy, safety, and pharmacokinetics of efanesoctocog alfa for prophylaxis and treatment of bleeding episodes in previously treated patients with severe hemophilia A are unclear. METHODS We conducted a phase 3 study involving patients 12 years of age or older with severe hemophilia A. In group A, patients received once-weekly prophylaxis with efanesoctocog alfa (50 IU per kilogram of body weight) for 52 weeks. In group B, patients received on-demand treatment with efanesoctocog alfa for 26 weeks, followed by once-weekly prophylaxis with efanesoctocog alfa for 26 weeks. The primary end point was the mean annualized bleeding rate in group A; the key secondary end point was an intrapatient comparison of the annualized bleeding rate during prophylaxis in group A with the rate during prestudy factor VIII prophylaxis. Additional end points included treatment of bleeding episodes, safety, pharmacokinetics, and changes in physical health, pain, and joint health. RESULTS In group A (133 patients), the median annualized bleeding rate was 0 (interquartile range, 0 to 1.04), and the estimated mean annualized bleeding rate was 0.71 (95% confidence interval [CI], 0.52 to 0.97). The mean annualized bleeding rate decreased from 2.96 (95% CI, 2.00 to 4.37) to 0.69 (95% CI, 0.43 to 1.11), a finding that showed superiority over prestudy factor VIII prophylaxis (P<0.001). A total of 26 patients were enrolled in group B. In the overall population, nearly all bleeding episodes (97%) resolved with one injection of efanesoctocog alfa. Weekly prophylaxis with efanesoctocog alfa provided mean factor VIII activity of more than 40 IU per deciliter for the majority of the week and of 15 IU per deciliter at day 7. Prophylaxis with efanesoctocog alfa for 52 weeks (group A) improved physical health (P<0.001), pain intensity (P = 0.03), and joint health (P = 0.01). In the overall study population, efanesoctocog alfa had an acceptable side-effect profile, and the development of inhibitors to factor VIII was not detected. CONCLUSIONS In patients with severe hemophilia A, once-weekly efanesoctocog alfa provided superior bleeding prevention to prestudy prophylaxis, normal to near-normal factor VIII activity, and improvements in physical health, pain, and joint health. (Funded by Sanofi and Sobi; XTEND-1 ClinicalTrials.gov number, NCT04161495.).
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Affiliation(s)
- Annette von Drygalski
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Pratima Chowdary
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Roshni Kulkarni
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Sophie Susen
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Barbara A Konkle
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Johannes Oldenburg
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Davide Matino
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Robert Klamroth
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Angela C Weyand
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Victor Jimenez-Yuste
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Keiji Nogami
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Stacey Poloskey
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Bent Winding
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Annemieke Willemze
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
| | - Karin Knobe
- From the Division of Hematology and Oncology, Department of Medicine, University of California, San Diego, San Diego (A.D.); the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London (P.C.); Michigan State University, East Lansing (R. Kulkarni); Centre Hospitalier Universitaire de Lille, Université de Lille, Lille (S.S.), and Sanofi, Chilly-Mazarin (K.K.) - both in France; the Washington Center for Bleeding Disorders and the University of Washington - both in Seattle (B.A.K.); the Institute of Experimental Hematology and Transfusion Medicine, Universitätsklinikum Bonn, Bonn (J.O.), and Vivantes Klinikum im Friedrichshain, Berlin (R. Klamroth) - both in Germany; the Division of Hematology and Thromboembolism, Department of Medicine, McMaster University, Hamilton, ON, Canada (D.M.); the Division of Hematology-Oncology, Department of Pediatrics, University of Michigan, Ann Arbor (A.C.W.); Hospital Universitario La Paz, Autónoma University, Madrid (V.J.-Y.); Nara Medical University, Nara, Japan (K.N.); Sanofi, Cambridge, MA (S.P.); Sobi, Stockholm (B.W.); and Sanofi, Amsterdam (A.W.)
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9
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Blazquez-Ramos N, Romero-Garrido JA, Gonzalez Del Valle L, Collada-Sanchez VL, Alvarez-Roman MT, Jimenez-Yuste V, Martin-Salces M, De la Corte-Rodriguez H, Herrero-Ambrosio A, Benedi-Gonzalez J, Rodriguez-Merchan EC. Development of a telematic pharmaceutical care app (Haemoassist) for multidisciplinary follow-up of patients with congenital coagulopathies. Expert Rev Hematol 2023; 16:213-226. [PMID: 36563352 DOI: 10.1080/17474086.2023.2162497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Guidelines for congenital coagulopathies recommend that patients record treatment administrations and bleeding episodes to help healthcare professionals monitor the disease. RESEARCH DESIGN AND METHODS We studied over two years which patient profiles (age, treatment regimen, treatment compliance) were most likely to accept the use of an app to collect this information. We validated the quality of patient-reported data by comparing it with data obtained from hospital electronic records, pharmacy dispensing records and patient interview, collected in an access database used as a reference. Patient and professional opinions were solicited through open-ended interviews. RESULTS The app was used by 52% of 315 patients studied. Younger patients were the most frequent users. Patients with better treatment compliance used the app more, although data collection was incomplete for most patients. The best rated by patients were the reminders of days of administration and the minimum stock alerts at home. Healthcare professionals rated the app positively. CONCLUSIONS Healthcare professionals valued the app as useful for managing treatment of congenital coagulopathies. Patients need support and time to use the app and improve the quality of the data entered. Patients who used the app rated it positively. The treatment compliance improved.
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Affiliation(s)
- Nuria Blazquez-Ramos
- Department of Pharmacy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain
| | - José A Romero-Garrido
- Department of Pharmacy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain.,Department of Pharmacology, Complutense University of Madrid, Madrid, Spain
| | - Luis Gonzalez Del Valle
- Department of Pharmacy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain
| | | | - María Teresa Alvarez-Roman
- IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain.,Department of Hematology, La Paz University Hospital, Madrid, Spain
| | - Victor Jimenez-Yuste
- IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain.,Department of Hematology, La Paz University Hospital, Madrid, Spain
| | - Monica Martin-Salces
- IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain.,Department of Hematology, La Paz University Hospital, Madrid, Spain
| | - Hortensia De la Corte-Rodriguez
- IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain.,Department of Physical Medicine and Rehabilitation, La Paz University Hospital, Madrid, Spain
| | - Alicia Herrero-Ambrosio
- Department of Pharmacy, La Paz University Hospital, Madrid, Spain.,IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain
| | | | - E Carlos Rodriguez-Merchan
- IdiPAZ, La Paz University Hospital Health Research Institute, Madrid, Spain.,Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Miesbach W, Baghaei F, Boban A, Chowdary P, Coppens M, Hart DP, Jimenez-Yuste V, Klamroth R, Makris M, Noone D, Peyvandi F. Gene therapy of hemophilia: Hub centres should be haemophilia centres: A joint publication of EAHAD and EHC. Haemophilia 2022; 28:e86-e88. [PMID: 35263819 DOI: 10.1111/hae.14546] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/22/2022] [Accepted: 02/27/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Wolfgang Miesbach
- Medical Clinic, Institute of Transfusion Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Fariba Baghaei
- Coagulation Centre, Department of Medicine, Section of Hematology and Coagulation, Sahlgrenska University Hospital and Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ana Boban
- Haemophilia Centre, Department of Haematology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Michiel Coppens
- Department of Vascular Medicine, Hemophilia Treatment Center, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniel P Hart
- The Royal London Hospital Haemophilia Centre, Barts and The London School of Medicine & Dentistry, QMUL, London, UK
| | - Victor Jimenez-Yuste
- Hematology Department, Hospital Universitario La Paz, Autonoma University, Madrid, Spain
| | - Robert Klamroth
- Department for Internal Medicine and Vascular Medicine, Haemophilia Treatment Center, Vivantes Hospital im Friedrichshain, Berlin, Germany
| | - Mike Makris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Declan Noone
- European Haemopilia Consortium, Brussels, Belgium
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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12
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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13
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Jimenez-Yuste V, Núñez L, Alvarez-Roman MT, Martin-Salces M, Haya S, Federici AB, Grifols C, Mairal E, Torres M, Páez A. Efficacy and safety evaluation of Fanhdi ® , a plasma-derived factor VIII/ von Willebrand factor concentrate, in Von Willebrand's disease patients undergoing surgery or invasive procedures: A prospective clinical study. Haemophilia 2022; 28:e23-e27. [PMID: 34735040 PMCID: PMC10015987 DOI: 10.1111/hae.14453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/18/2021] [Accepted: 10/23/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Victor Jimenez-Yuste
- Department of Hematology and Hemotherapy, Hospital Universitario La Paz, Autónoma University, Madrid, Spain
| | - Laura Núñez
- Bioscience Research Group, Grifols, Sant Cugat del Vallès, Barcelona, Spain
| | - Maria Teresa Alvarez-Roman
- Department of Hematology and Hemotherapy, Hospital Universitario La Paz, Autónoma University, Madrid, Spain
| | - Monica Martin-Salces
- Department of Hematology and Hemotherapy, Hospital Universitario La Paz, Autónoma University, Madrid, Spain
| | - Saturnino Haya
- Hemostasis and Thrombosis Unit, Hematology Service, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Augusto B Federici
- Department of Haematology and Haemotherapy Luigi Sacco Hospital, Milano, Italy
| | - Carlota Grifols
- Bioscience Research Group, Grifols, Sant Cugat del Vallès, Barcelona, Spain
| | - Esther Mairal
- Scientific & Medical Affairs, Grifols, Sant Cugat del Vallès, Barcelona, Spain
| | - Mireia Torres
- Bioscience Research Group, Grifols, Sant Cugat del Vallès, Barcelona, Spain
| | - Antonio Páez
- Bioscience Research Group, Grifols, Sant Cugat del Vallès, Barcelona, Spain
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14
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De la Corte-Rodriguez H, Rodriguez-Merchan EC, Alvarez-Roman MT, Martin-Salces M, Jimenez-Yuste V. Clinical assessment and point of care ultrasonography: How to diagnose haemophilic synovitis. Haemophilia 2021; 28:138-144. [PMID: 34668289 DOI: 10.1111/hae.14441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/28/2021] [Accepted: 10/07/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The ability of clinical tools to identify early joint changes is limited. Synovitis is a fundamental finding in understanding haemophilia activity and the response to its therapies; thus, there is a need for sensitive methods to better diagnose subclinical synovitis early. PURPOSE Our aim was to compare the frequency with which clinical assessment and ultrasound detected synovial hypertrophy in the most frequently affected joints in patients with haemophilia (elbows, knees and ankles). METHODS We analysed patients with haemophilia older than 16 years who came to the haemophilia centre for routine follow-up. From the clinical assessment carried out in the consultation, the swelling, pain and history of haemarthrosis were evaluated and compared with the findings of synovial hypertrophy detected by ultrasound. This comparison was also analysed independently for elbows, knees and ankles. RESULTS A total of 203 joints of 66 patients with haemophilia (mean age 34 years), most of them on secondary, tertiary prophylaxis or on demand treatment, were included. In joints with swelling, pain and history of haemarthrosis, 78% of the joints showed synovial hypertrophy on ultrasound. However, in joints with no swelling, no pain and no history of haemarthrosis, 40% presented subclinical synovial hypertrophy on ultrasound. This percentage was higher in elbows than in knees and ankles. CONCLUSION In adults with haemophilia, physical examination and point-of-care ultrasound study provide complementary data on their joint disease. However, without ultrasound, the ability to detect subclinical synovitis is considerably reduced, especially in the elbows.
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Affiliation(s)
| | - E Carlos Rodriguez-Merchan
- Department of Orthopaedic 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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15
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Miesbach W, Chowdary P, Coppens M, Hart DP, Jimenez-Yuste V, Klamroth R, Makris M, Noone D, Peyvandi F. Delivery of AAV-based gene therapy through haemophilia centres-A need for re-evaluation of infrastructure and comprehensive care: A Joint publication of EAHAD and EHC. Haemophilia 2021; 27:967-973. [PMID: 34553460 DOI: 10.1111/hae.14420] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Adeno-associated virus (AAV)-based gene therapy for haemophilia presents a challenge to the existing structure of haemophilia centres and requires a rethink of current collaboration and information exchange with the aim of ensuring a system that is fit-for-purpose for advanced therapies to maximise benefits and minimise risks. In Europe, a certification process based on the number of patients and facilities is offered to the haemophilia centres by European Haemophilia Network (EUHANET). AIM AND METHODS This joint European Association for Haemophilia and Allied Disorders (EAHAD) and European Haemophilia Consortium (EHC) publication describes criteria for centres participating in gene therapy care that require a reassessment of the infrastructure of comprehensive care and provides an outlook on how these criteria can be implemented in the future work of haemophilia centres. RESULTS The core definition of a haemophilia treatment centre remains, but additional roles could be implemented. A modifiable 'hub-and-spoke' model addresses all aspects associated with gene therapy, including preparation and administration of the gene therapy product, determination of coagulation and immunological parameters, joint score and function, and liver health. This will also include the strategy on how to follow-up patients for a long-term safety and efficacy surveillance. CONCLUSION We propose a modifiable, networked 'hub and spoke' model with a long term safety and efficacy surveillance system. This approach will be progressively developed with the goal of making haemophilia centres better qualified to deliver gene therapy and to make gene therapy accessible to all persons with haemophilia, irrespective of their country or centre of origin.
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Affiliation(s)
- Wolfgang Miesbach
- Medical Clinic 2, Institute of Transfusion Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - Pratima Chowdary
- Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK
| | - Michiel Coppens
- Department of Vascular Medicine, Haemophilia Treatment Centre, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniel P Hart
- The Royal London Hospital Haemophilia Centre, Barts and The London School of Medicine and Dentistry, QMUL, London, UK
| | - Victor Jimenez-Yuste
- Hematology Department, Hospital Universitario La Paz, Autonoma University, Madrid, Spain
| | - Robert Klamroth
- Department for Internal Medicine and Vascular Medicine, Haemophilia Treatment Centre, Vivantes Hospital im Friedrichshain, Berlin, Germany
| | - Michael Makris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Declan Noone
- European Haemophilia Consortium, Brussels, Belgium
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre and Fondazione Luigi Villa, Milan, Italy.,Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
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Liesner RJ, Abraham A, Altisent C, Belletrutti MJ, Carcao M, Carvalho M, Chambost H, Chan AKC, Dubey L, Ducore J, Gattens M, Gresele P, Gruel Y, Guillet B, Jimenez-Yuste V, Kitanovski L, Klukowska A, Lohade S, Mancuso ME, Oldenburg J, Pavlova A, Pollio B, Sigaud M, Vdovin V, Vilchevska K, Wu JKM, Jansen M, Belyanskaya L, Walter O, Knaub S, Neufeld EJ. Simoctocog Alfa (Nuwiq) in Previously Untreated Patients with Severe Haemophilia A: Final Results of the NuProtect Study. Thromb Haemost 2021; 121:1400-1408. [PMID: 33581698 PMCID: PMC8570909 DOI: 10.1055/s-0040-1722623] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction
FVIII inhibitor development is the most serious contemporary treatment complication in haemophilia A, particularly in previously untreated patients (PUPs). No inhibitors developed in clinical trials in previously treated patients treated with simoctocog alfa (Nuwiq), a fourth-generation recombinant FVIII produced in a human cell line.
Methods
The NuProtect study investigated the immunogenicity of simoctocog alfa in PUPs. NuProtect was a prospective, multinational, open-label, non-controlled, phase III study. PUPs with severe haemophilia A (FVIII:C <1%) of any age and ethnicity were treated with simoctocog alfa for 100 exposure days or a maximum of 5 years. Patients were true PUPs without prior exposure to FVIII concentrates or blood components. Inhibitor titres were measured with the Nijmegen-modified Bethesda assay; cut-off for positivity was 0.6 BU mL
−1
(≥0.6 to <5 low-titre, ≥5 high titre).
Results
A total of 108 PUPs with a median age at first treatment of 12.0 months (interquartile range: 8.0–23.5) were treated with simoctocog alfa.
F8
mutation type was known for 102 patients (94.4%) of whom 90 (88.2%) had null
F8
mutations and 12 (11.8%) had non-null mutations. Of 105 PUPs evaluable for inhibitor development, 28 (26.7%) developed inhibitors; 17 high titre (16.2%) and 11 low titre (10.5%). No PUPs with non-null
F8
mutations developed inhibitors.
Conclusion
In the NuProtect study, the rate of inhibitor development in PUPs with severe haemophilia A treated with simoctocog alfa was lower than the rate reported for hamster-cell-derived recombinant factor VIII products in other recent clinical trials. No inhibitors were reported in PUPs with non-null
F8
mutations.
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Affiliation(s)
- Ri J Liesner
- Great Ormond Street Hospital for Children NHS Trust Haemophilia Centre, NIHR GOSH BRC, London, United Kingdom
| | - Aby Abraham
- Department of Hematology, Christian Medical College, Vellore, India
| | - Carmen Altisent
- Unitat d'Hemofilia, Hospital Vall D'Hebron, Barcelona, Spain
| | - Mark J Belletrutti
- Pediatric Hematology, Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Manuel Carcao
- Division of Haematology/Oncology and Child Health Evaluative Sciences, Department of Paediatrics, Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Manuela Carvalho
- Congenital Coagulopathies Reference Centre, São João University Hospital Centre, Porto, Portugal
| | - Hervé Chambost
- AP-HM, Department of Pediatric Hematology Oncology, Children Hospital La Timone, Aix Marseille Univ, INSERM, INRA, C2VN, Marseille, France
| | - Anthony K C Chan
- Division of Pediatric Hematology/Oncology, McMaster University, Hamilton, Canada
| | - Leonid Dubey
- Department of Pediatrics, Western Ukrainian Specialized Children's Medical Centre, Lviv, Ukraine
| | - Jonathan Ducore
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, United States
| | - Michael Gattens
- Department of Paediatric Haematology and Oncology, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Paolo Gresele
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Yves Gruel
- Centre Régional de Traitement de l'Hémophilie, Hôpital Trousseau, Tours, France
| | - Benoit Guillet
- Haemophilia Treatment Centre, Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Victor Jimenez-Yuste
- Servicio de Hematología, Hospital Univeristario La Paz, Autónoma University, Madrid, Spain
| | - Lidija Kitanovski
- Department of Haemato-Oncology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Anna Klukowska
- Department of Pediatrics, Haematology and Oncology, Warsaw Medical University, Warsaw, Poland
| | - Sunil Lohade
- Department of Hematology, Sahyadri Speciality Hospital, Pune, India
| | - Maria Elisa Mancuso
- Center for Thrombosis and Hemorrhagic Diseases, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Johannes Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
| | - Anna Pavlova
- Institute of Experimental Haematology and Transfusion Medicine, University Clinic Bonn, Bonn, Germany
| | - Berardino Pollio
- Department of Transfusion Medicine, Regina Margherita Children Hospital of Turin, Turin, Italy
| | - Marianne Sigaud
- Centre Régional de Traitement de I'Hémophilie, University Hospital of Nantes, Nantes, France
| | - Vladimir Vdovin
- Department of Hematology, Morozovskaya Children's Hospital, Moscow, Russian Federation
| | - Kateryna Vilchevska
- Department of Hematology, State Institution "Institute of Urgent and Reconstructive Surgery named after V.K. Gusak of National Academy of Medical Sciences of Ukraine," Donetsk, Ukraine
| | - John K M Wu
- British Columbia Children's Hospital, Vancouver, Canada
| | - Martina Jansen
- Octapharma Pharmazeutika Produktionsges.mbH, Vienna, Austria
| | | | | | | | - Ellis J Neufeld
- St. Jude Children's Research Hospital, Memphis, Tennessee, United States
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17
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De la Corte-Rodriguez H, Rodriguez-Merchan EC, Alvarez-Roman MT, Martin-Salces M, Jimenez-Yuste V. 'Do not Do' Recommendations in Hemophilia. Cardiovasc Hematol Disord Drug Targets 2020; 20:168-174. [PMID: 32133968 DOI: 10.2174/1871529x20666200305111323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/20/2020] [Accepted: 02/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND It is important to discard those practices that do not add value. As a result, several initiatives have emerged. All of them try to improve patient safety and the use of health resources. PURPOSE To present a compendium of "do not do recommendations" in the context of hemophilia. METHODS A review of the literature and current clinical guidelines has been made, based on the best evidence available to date. RESULTS The following 13 recommendations stand out: 1) Do not delay the administration of factor after trauma; 2) do not use fresh frozen plasma or cryoprecipitate; 3) do not use desmopressin in case of hematuria; 4) do not change the product in the first 50 prophylaxis exposures; 5) do not interrupt immunotolerance; 6) do not administer aspirin or NSAIDs; 7) do not administer intramuscular injections; 8) do not do routine radiographs of the joint in case of acute hemarthrosis; 9) Do not apply closed casts for fractures; 10) do not discourage the performance of physical activities; 11) do not deny surgery to a patient with an inhibitor; 12) do not perform instrumental deliveries in fetuses with hemophilia; 13) do not use factor IX (FIX) in patients with hemophilia B with inhibitor and a history of anaphylaxis after administration of FIX. CONCLUSION The information mentioned previously can be useful in the management of hemophilia, from different levels of care. As far as we know, this is the first initiative of this type regarding hemophilia.
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18
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De la Corte-Rodriguez H, Rodriguez-Merchan EC, Alvarez-Roman T, Martin-Salces M, Garcia-Barcenilla S, Jimenez-Yuste V. Health education and empowerment in adult patients with haemophilia. Expert Rev Hematol 2019; 12:989-995. [PMID: 31393181 DOI: 10.1080/17474086.2019.1650640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: The purpose of this study is to evaluate the degree of education and empowerment of the patients of the Haemophilia Unit at 'La Paz' University Hospital (Madrid, Spain).Materials and methods: Haemophilic patients attending routine haemophilia consultations were asked to complete a questionnaire with a view to determining the patient´s perceived knowledge about the disease; their ability to make individual and group decisions; and whether the frequency of their hospital visits could be reduced.Results: Patients were shown to have ample knowledge about the disease. Knowledge had been acquired chiefly through personal experience and from the interaction with healthcare providers. Nearly 70% of patients felt capable of making decisions on matters affecting their health. Over half of the patients considered that their hospital visits could be reduced if they had more information. Patients experiencing the largest number of bleeding episodes were those showing the highest levels of empowerment. Over half the patients were satisfied with the institutional support they received.Conclusion: These patients with haemophilia are in general reasonably empowered on account of their personal experiences and their interaction with the healthcare providers. Current widespread access to information makes it easier to step up educational interventions in patients at lower haemorrhagic risk.
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19
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Santagostino E, Young G, Escuriola Ettingshausen C, Jimenez-Yuste V, Carcao M. Inhibitors: A Need for Eradication? Acta Haematol 2019; 141:151-155. [PMID: 30783066 DOI: 10.1159/000495454] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 11/14/2018] [Indexed: 01/19/2023]
Abstract
The development of inhibitors against factor VIII (FVIII) concentrates represents a significant treatment complication for hemophilia. Immune tolerance induction (ITI) therapy eradicates inhibitors in 60-80% of patients, resulting in a normal FVIII response. This article, based on presentations at the 6th International Coagulation Meeting, held in Barcelona, Spain, in September 2017, provides an overview of management approaches for patients with inhibitors and briefly tabulates four cases of ITI therapy (first-line or rescue ITI therapy in pediatric and adult patients) with successful outcomes. Switching FVIII product from recombinant FVIII to plasma-derived FVIII/VWF concentrate may be helpful in eradicating inhibitors. The rate of decline of inhibitor titer in the initial stages of ITI therapy is a good indicator of the success or failure of therapy, although prognostic biomarkers are needed. The development of the bispecific monoclonal antibody emicizumab, which was recently shown to reduce bleeding in inhibitor patients, offers a potential alternative therapeutic option. However, the benefits of inhibitor eradication, including a wider choice of cheaper therapeutic products for preventing and treating bleeds, suggest that at least one attempt of ITI therapy should be offered to patients who develop inhibitors.
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Affiliation(s)
- Elena Santagostino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy,
| | - Guy Young
- Hemostasis and Thrombosis Center, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | | | - Victor Jimenez-Yuste
- Hematology Department, Hospital Universitario La Paz, Autónoma University, IdiPaz, Madrid, Spain
| | - Manuel Carcao
- Division of Hematology/Oncology, Department of Pediatrics and Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
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20
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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: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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González-Porras J, Jiménez C, Benito R, Ordoñez GR, Álvarez-Román M, Fontecha ME, Janusz K, Castillo D, Fisac R, García-Frade L, Aguilar C, Martínez P, Bermejo N, Herrero S, Balanzategui A, Martin-Antorán J, Ramos R, Cebeiro M, Pardal E, Aguilera C, Pérez-Gutierrez B, Prieto M, Riesco S, Mendoza M, Benito A, Benito-Sendin A, Jimenez-Yuste V, Hernández-Rivas J, García-Sanz R, González-Díaz M, Sarasquete M, Bastida J. Application of a molecular diagnostic algorithm for haemophilia A and B using next-generation sequencing of entire F8, F9 and VWF genes. Thromb Haemost 2017; 117:66-74. [DOI: 10.1160/th16-05-0375] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 09/17/2016] [Indexed: 12/30/2022]
Abstract
SummaryCurrently, molecular diagnosis of haemophilia A and B (HA and HB) highlights the excess risk-inhibitor development associated with specific mutations, and enables carrier testing of female relatives and prenatal or preimplantation genetic diagnosis. Molecular testing for HA also helps distinguish it from von Willebrand disease (VWD). Next-generation sequencing (NGS) allows simultaneous investigation of several complete genes, even though they may span very extensive regions. This study aimed to evaluate the usefulness of a molecular algorithm employing an NGS approach for sequencing the complete F8, F9 and VWF genes. The proposed algorithm includes the detection of inversions of introns 1 and 22, an NGS custom panel (the entire F8, F9 and VWF genes), and multiplex ligation-dependent probe amplification (MLPA) analysis. A total of 102 samples (97 FVIII- and FIX-deficient patients, and five female carriers) were studied. IVS-22 screening identified 11 out of 20 severe HA patients and one female carrier. IVS-1 analysis did not reveal any alterations. The NGS approach gave positive results in 88 cases, allowing the differential diagnosis of mild/moderate HA and VWD in eight cases. MLPA confirmed one large exon deletion. Only one case did have no pathogenic variants. The proposed algorithm had an overall success rate of 99 %. In conclusion, our evaluation demonstrates that this algorithm can reliably identify pathogenic variants and diagnose patients with HA, HB or VWD.Supplementary Material to this article is available online at www.thrombosis-online.com.
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22
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Nemes L, Jimenez-Yuste V, Rusen L, Cid A, Charnigo R, Baumann J, Smith L, Korth-Bradley J, Rendo P, Lopez RP. Prospective surveillance study of haemophilia A patients switching from moroctocog alfa or other factor VIII products to moroctocog alfa albumin-free cell culture (AF-CC) in usual care settings. Thromb Haemost 2017; 114:676-84. [DOI: 10.1160/th14-09-0760] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 04/29/2015] [Indexed: 01/21/2023]
Abstract
SummaryThis prospective, open-label, postauthorisation safety surveillance study assessed clinically significant inhibitor development in patients with severe haemophilia A transitioning from moroctocog alfa or other factor VIII (FVIII) replacement products to reformulated moroctocog alfa (AF-CC). Males aged12 years with severe haemophilia A (FVIII:C) < 1 IU/dl), > 150 exposure days (EDs) to recombinant or plasma-derived FVIII products, and no detectable inhibitor at screening were enrolled. Primary end point was the incidence of clinically significant FVIII inhibitor development. Secondary end points included annualised bleeding rate (ABR), less-than-expected therapeutic effect (LETE), and FVIII recovery. Patients were assigned to one of two cohorts based on whether they were transitioning to moroctocog alfa (AF-CC) from moroctocog alfa (cohort 1; n=146) or from another recombinant or plasma-derived FVIII product (cohort 2; n=62). Mean number of EDs on study was 94 (range, 1–139). Six positive FVIII inhibitor results, as determined by local laboratories, were reported in four patients; none were confirmed by a central laboratory, no inhibitor-related clinical manifestations were reported, and all anti-FVIII antibody assays were negative. Median ABRs were 23.4 and 3.4 in patients categorised at baseline as following on-demand and prophylactic regimens, respectively; 86.5 % of bleeding episodes resolved after one infusion. LETE incidence was 0.06 % and 0.19 % in the on-demand and prophylaxis settings, respectively. FVIII recovery remained constant throughout the study. No new safety concerns were identified. This study found no increased risk of clinically significant FVIII inhibitor development in patients transitioning from moroctocog alfa or other FVIII replacement products to moroctocog alfa (AF-CC).
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23
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van Velzen AS, Eckhardt CL, Hart DP, Peters M, Rangarajan S, Mancuso ME, Smiers FJ, Khair K, Petrini P, Jimenez-Yuste V, Hay CRM, van der Bom JG, Yee TT, Fijnvandraat K. Inhibitors in nonsevere haemophilia A: outcome and eradication strategies. Thromb Haemost 2017; 114:46-55. [DOI: 10.1160/th14-11-0940] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 02/13/2015] [Indexed: 02/03/2023]
Abstract
SummaryIn nonsevere haemophilia A (HA) patients the presence of an inhibitor may exacerbate the bleeding phenotype dramatically. There are very limited data on the optimal therapeutic approach to eradicate inhibitors in these patients. We aimed to describe inhibitor eradication treatment in a large cohort of unselected nonsevere HA patients with inhibitors. We included 101 inhibitor patients from a source population of 2,709 nonsevere HA patients (factor VIII 2–40 IU/dl), treated in Europe and Australia (median age 37 years, interquartile range (IQR) 15–60; median peak titre 7 BU/ml, IQR 2–30). In the majority of the patients (71 %; 72/101) the inhibitor disappeared; either spontaneously (70 %, 51/73) or after eradication treatment (75 %, 21/28). Eradication treatment strategies varied widely, including both immune tolerance induction and immunosuppression. Sustained success (no inhibitor after rechallenge with factor VIII concentrate after inhibitor disappearance) was achieved in 64 % (30/47) of those patients rechallenged with FVIII concentrate. In high-titre inhibitor patients sustained success was associated with eradication treatment (unadjusted relative risk 2.3, 95 % confidence interval 1.3–4.3), compared to no eradication treatment. In conclusion, in nonsevere HA patients most inhibitors disappear spontaneously. However, in 35 % (25/72) of these patients an anamnestic response still can occur when rechallenged, thus disappearance in these patients does not always equal sustained response. Treatment for those requiring eradication has to be decided case by case, as one single approach is unlikely to be appropriate for all.Study was carried out in: Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands.
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24
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Rodriguez-Merchan EC, De la Corte-Rodriguez H, Jimenez-Yuste V. Radiosynovectomy in haemophilia: long-term results of 500 procedures performed in a 38-year period. Thromb Res 2014; 134:985-90. [PMID: 25240555 DOI: 10.1016/j.thromres.2014.08.023] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 08/19/2014] [Accepted: 08/23/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radiosynovectomy (RS) can reduce the number of haemarthroses in chronic haemophilic synovitis. The purpose of this study was to assess the effectiveness of RS in terms of the objective improvement of five parameters (number haemarthroses, articular pain, degree of clinical synovitis, clinical score of the World Federation of Haemophilia (WFH), and radiological score of the WFH. METHODS In a 38-year period (1976-2013), five hundred radiosynovectomies were performed in 443 joints of 345 patients with haemophilia diagnosed with chronic synovitis. The mean patient age was 23.7 years (range, 6-53). The mean follow-up was 18.5 years (range: 6 months-38 years). The RS was carried out with either yttrium-90 or rhenium-186. We performed 1 to 3 injections (RS-1, RS-2, RS-3), with a 6-month interval between them. RESULTS RS resulted in significant improvement in all the parameters studied, except in the WFH radiologic score that showed no improvement. On average, the number of haemarthroses decreased by 64.1% and articular pain decreased by 69.4%. The degree of synovitis showed a reduction of 31.3%. The WFH clinical score revealed an improvement of 19%. The WFH radiological score showed no improvement. There were four complications (0.9%) of RS. Twenty-eight (6.3%) joints eventually had to be subjected to arthroscopic synovectomy or total knee replacement (TKR). No cancer was observed in this group of patients during the 38-year period. CONCLUSIONS Radiosynovectomy (RS) is an effective, safe, minimally invasive, well tolerated procedure in the long-term for the treatment of chronic haemophilic synovitis. Moreover, it is very easy to perform. The knee required more injections than the elbow or the ankle and more severe synoviums required a higher number of RS procedures.
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Affiliation(s)
| | - H De la Corte-Rodriguez
- Department of Rehabilitation and Physical Therapy, La Paz University Hospital, Madrid, Spain
| | - V Jimenez-Yuste
- Department of Haematology, La Paz University Hospital, Madrid, Spain
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25
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Rodriguez-Merchan E, De La Corte-Rodriguez H, Jimenez-Yuste V. Is radiosynovectomy (RS) effective for joints damaged by haemophilia with articular degeneration in simple radiography (ADSR)? Thromb Res 2014; 133:875-9. [DOI: 10.1016/j.thromres.2014.01.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 12/18/2013] [Accepted: 01/26/2014] [Indexed: 10/25/2022]
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26
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Rodriguez-Merchan EC, de la Corte-Rodriguez H, Jimenez-Yuste V. Efficacy of celecoxib in the treatment of joint pain caused by advanced haemophilic arthropathy in adult patients with haemophilia A. Haemophilia 2014; 20:e225-7. [DOI: 10.1111/hae.12393] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - V. Jimenez-Yuste
- Department of Haematology; La Paz University Hospital; Madrid Spain
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27
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Rodriguez-Merchan EC, De la Corte-Rodriguez H, Jimenez-Yuste V. Joint aspiration of acute tense knee haemarthroses in adult haemophilia A patients. Thromb Res 2013; 132:778-9. [DOI: 10.1016/j.thromres.2013.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 09/19/2013] [Accepted: 09/20/2013] [Indexed: 10/26/2022]
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28
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Rodriguez-Merchan EC, Jimenez-Yuste V, Gomez-Cardero P, Rodriguez T. Severe postoperative haemarthrosis following a total knee replacement in a haemophiliac patient caused by a pseudoaneurysm: early treatment with arterial embolization. Haemophilia 2013; 20:e86-9. [PMID: 24165398 DOI: 10.1111/hae.12286] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2013] [Indexed: 11/28/2022]
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29
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Jimenez-Yuste V, Núñez R, Romero JA, Montoro B, Espinós B. Cost-effectiveness of recombinant activated factor VII vs. plasma-derived activated prothrombin complex concentrate in the treatment of mild-to-moderate bleeding episodes in patients with severe haemophilia A and inhibitors in Spain. Haemophilia 2013; 19:841-6. [DOI: 10.1111/hae.12199] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2013] [Indexed: 11/27/2022]
Affiliation(s)
- V. Jimenez-Yuste
- Hospital Universitario La Paz; Autonoma University; Madrid Spain
| | - R. Núñez
- Hospital Virgen del Rocío; Sevilla Spain
| | - J. A. Romero
- Hospital Universitario La Paz; Autonoma University; Madrid Spain
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De La Corte-Rodriguez H, Rodriguez-Merchan EC, Jimenez-Yuste V. Consecutive radiosynovectomy procedures at 6-monthly intervals behave independently in haemophilic synovitis. Blood Transfus 2013; 11:254-9. [PMID: 23245712 PMCID: PMC3626478 DOI: 10.2450/2012.0099-12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 06/05/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND Previous studies on the same group of patients investigated here demonstrated the effectiveness of radiosynovectomy in the treatment of chronic haemophilic synovitis even if one, two or three radiosynovectomy procedures (RS-1, RS-2, RS-3) may be necessary. The purpose of this study was to determine whether the joints' response to each radiosynovectomy procedure behaved independently or not. MATERIALS AND METHODS One hundred and fifty-six radiosynovectomies were performed in 104 joints of 78 people diagnosed with chronic haemophilic synovitis. The patient's mean age was 18 years. Fifty-eight patients required radiosynovectomy in a single joint, whereas 20 received treatment in more than one joint. Of the 104 joints subjected to radiosynovectomy, 33 were elbows, 47 knees and 24 ankles. Radiosynovectomy was carried out with either yttrium-90 or rhenium-186 (1-3 injections with 6-month intervals between them). Of the 104 joints, 68 required a single injection of the radioisotope (RS-1), 20 required two injections (RS-2) and 16 required three injections (RS-3). In eight cases (7.6%), the affected joints eventually required surgery. RESULTS An analysis of seven variables (number of bleeding episodes, articular pain, range of motion in flexion and extension, muscle strength in flexion and extension, and synovial thickness by imaging) demonstrated that each consecutive radiosynovectomy behaves independently in haemophilic synovitis. DISCUSSION Each consecutive radiosynovectomy behaves independently in haemophilic synovitis. This finding had not been documented in the literature before the present study.
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Young G, Auerswald G, Jimenez-Yuste V, Lambert T, Morfini M, Santagostino E, Blanchette V. PRO-PACT: Retrospective observational study on the prophylactic use of recombinant factor VIIa in hemophilia patients with inhibitors. Thromb Res 2012; 130:864-70. [DOI: 10.1016/j.thromres.2012.08.305] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 08/16/2012] [Accepted: 08/21/2012] [Indexed: 11/29/2022]
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Rodriguez-Merchan EC, Gomez-Cardero P, Jimenez-Yuste V, Rico-Nieto A. A complex case of infected total knee arthroplasty in a haemophilic patient with inhibitor. Haemophilia 2012; 18:e357-9. [PMID: 22536792 DOI: 10.1111/j.1365-2516.2012.02815.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rodriguez-Merchan EC, Gomez-Cardero P, Jimenez-Yuste V. Iatrogenic fracture of the proximal tibia as a complication of knee manipulation under anaesthesia in a haemophilia patient with an ipsilateral stiff knee secondary to a supracondylar non-union of the femur. Haemophilia 2012; 18:e354-6. [PMID: 22537651 DOI: 10.1111/j.1365-2516.2012.02814.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rodriguez-Merchan EC, Jimenez-Yuste V. An uncommon cause of elbow synovitis in an adult haemophilia patient. Blood Coagul Fibrinolysis 2012; 23:459-60. [PMID: 22527294 DOI: 10.1097/mbc.0b013e328353ce08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We present the case of an adult haemophilia patient that at clinical examination showed intense painless synovitis in his left elbow, with full range of movement, which was unresponsive to 1 month of on-demand haematologic treatment at home. Radiological examination demonstrated a spontaneous displaced fracture of the olecranon secondary to severe osteolysis, due to advanced haemophilic arthropathy. Then, the patient was treated with a posterior plaster splint to immobilize the joint for 3 weeks together with secondary prophylaxis (3000 IU twice a week for 3 months). One month later the patient was better, with full range of movement, and the amount of swelling had improved. Regarding the outcome of the fracture, 6 months later there was no healing of the fracture, and the patient developed a painless nonunion that allowed him to return to his preinjury activities of daily living. As far as we know, this rare combination of problems (unresponsive synovitis, severe haemophilic arthropathy, spontaneous elbow fracture) has not been previously published in the literature.
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Rodriguez-Merchan EC, Jimenez-Yuste V, Valentino LA. An uncommon cause of knee haemarthrosis in an adult haemophilia patient suffering from long-term paraplegia. Haemophilia 2011; 17:e845-e846. [PMID: 21682822 DOI: 10.1111/j.1365-2516.2011.02597.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Rodriguez-Merchan EC, Gomez-Cardero P, Jimenez-Yuste V. Late avascular necrosis of the femoral head (anfh) after the percutaneous fixation of a non-displaced fracture of the femoral neck in a haemophilic patient with inhibitors: a non-reported association. Haemophilia 2011; 18:e4-5. [PMID: 21752161 DOI: 10.1111/j.1365-2516.2011.02618.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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De la Corte-Rodriguez H, Rodriguez-Merchan EC, Jimenez-Yuste V. Radiosynovectomy in hemophilia: quantification of its effectiveness through the assessment of 10 articular parameters. J Thromb Haemost 2011; 9:928-35. [PMID: 21352468 DOI: 10.1111/j.1538-7836.2011.04246.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Radiosynovectomy (RS) can reduce the number of hemarthroses in chronic hemophilic synovitis. The purpose of this study was to quantitatively assess the effectiveness of RS in terms of the objective improvement of ten articular parameters. METHODS One-hundred and fifty-six radiosynovectomies were performed in 104 joints of 78 hemophiliacs diagnosed with chronic synovitis. The mean patient age was 18 years. The RS was carried out with either yttrium-90 or rhenium-186 (1-3 injections with a 6-month interval between them). RESULTS RS resulted in significant improvement in nine of the 10 variables studied, namely in the number of episodes of hemarthrosis, articular pain, range of motion (ROM) in flexion. ROM in extension, muscle strength (MS) in flexion, MS in extension, the degree of synovitis detected on clinical examination, the size of the synovium as measured by means of imaging techniques (in millimeters), the clinical scale developed by the World Federation of Haemophilia (WFH), and the radiologic scale of the WFH. The tenth parameter, the WFH radiologic score, showed no improvement. The other nine parameters studied improved independently for each one of the intra-articular injections of the radioisotope. CONCLUSIONS Categorization of the variables with regard to the degree of improvement achieved showed that the number of episodes of hemarthrosis and the severity of pain were the variables associated with the greatest improvement, with a 70% decrease in the amount of bleeding and in the level of pain experienced by the patient. The reduction of articular bleeding after RS was 67.6% when RS-1 was used, 62.1% with RS-2 and 61.2% with RS-3. Synovial hypertrophy as assessed clinically and by imaging techniques also showed a reduction of 30% and 39%, respectively. The WFH clinical scale revealed an improvement of around 19%. MS also improved in flexion and extension (7.9% and 8.2% improvement, respectively). ROM showed a slight but non-significant improvement.
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Affiliation(s)
- H De la Corte-Rodriguez
- Department of Rehabilitation and Physical Therapy, La Paz University Hospital, Madrid, Spain
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de la Corte-Rodriguez H, Rodriguez-Merchan EC, Jimenez-Yuste V. What patient, joint and isotope characteristics influence the response to radiosynovectomy in patients with haemophilia? Haemophilia 2011; 17:e990-8. [PMID: 21535325 DOI: 10.1111/j.1365-2516.2011.02546.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The literature describes radiosynovectomy (RS) as a good non-surgical option for reducing synovial membrane size and thus the number of haemarthrosis episodes. However, there are still many aspects concerning the beneficial effects of RS that have not been quantified. A total of 156 radiosynovectomies (RS) were performed in 104 joints corresponding to 78 haemophiliacs (yttrium-90, rhenium-186). The mean patient age was 18 years. In another study involving the same group of patients, the parameters that improved most after RS were pain and haemarthrosis, followed by the World Federation of Hemophilia clinical score, muscle strength and range of movement (ROM). Following RS, improvement was seen to be independent of patient age, haemophilia type and grade, previous haematological treatment, the presence or absence of circulating inhibitor, synovial membrane size, the type of joint (elbow, knee and ankle), previous physical activity or lack of activity, the prior presence or absence of radiographic signs of joint degeneration (arthropathy) or the isotope used. RS is effective in treating haemophilic synovitis and may require 1-3 injections (RS-1, RS-2 and RS-3) spaced 6 months apart. Following RS-1, the knee had a 3.4- and 3.2-fold greater risk of not improving in terms of pain, compared with the elbow and ankle, respectively. Regarding ROM, lesser improvement was recorded after RS-1 in cases of severe haemophilia and the ankle. In other words, severe haemophilia implies a 2.1-fold greater risk of no improvement in ROM compared with mild and moderate haemophilia. In addition, the ankle presented a 6-fold greater risk of not improving in terms of ROM compared with the elbow and knee. RS affords effective treatment of chronic haemophilic synovitis. RS is effective in all patient groups, independently of the presence of circulating inhibitor antibody, the type of joint involved, the degree of synovial membrane hypertrophy and the presence of radiographic findings of joint degeneration (arthropathy).
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Affiliation(s)
- H de la Corte-Rodriguez
- Department of Rehabilitation and Physical Therapy, La Paz University Hospital, Madrid, Spain
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Rodriguez-Merchan EC, Gomez-Cardero P, Jimenez-Yuste V. Infection after total knee arthroplasty in haemophilic arthropathy with special emphasis on late infection. Haemophilia 2011; 17:e831-2. [PMID: 21507150 DOI: 10.1111/j.1365-2516.2011.02530.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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de la Corte-Rodriguez H, Rodriguez-Merchan EC, Jimenez-Yuste V. Radiosynovectomy in patients with chronic haemophilic synovitis: when is more than one injection necessary? Eur J Haematol 2011; 86:430-5. [PMID: 21306434 DOI: 10.1111/j.1600-0609.2011.01583.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Young G, Auerswald G, Jimenez-Yuste V, Konkle BA, Lambert T, Morfini M, Santagostino E, Blanchette V. When should prophylaxis therapy in inhibitor patients be considered? Haemophilia 2011; 17:e849-57. [PMID: 21418444 DOI: 10.1111/j.1365-2516.2011.02494.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Currently, patients with severe haemophilia can expect to lead a relatively normal life including prevention of disabling arthropathy as a result of the development of factor replacement therapy and advances in the understanding of the use of such therapy given prophylactically. Unfortunately, a subset of patients develops neutralizing antibodies termed inhibitors rendering such therapy ineffective. These patients frequently develop recurrent joint bleeding resulting in arthropathy. Until recently, prophylactic therapy was not considered for patients with inhibitors because of the perceived lack of an effective therapeutic agent. However, an accumulation of case reports and a recent prospective study have suggested that prophylaxis with the currently available bypassing agents could be effective and appears to be safe in selected cases. This report will review the current data on prophylaxis with bypassing agents and suggest specific situations in which prophylaxis in inhibitor patients could be considered.
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Affiliation(s)
- G Young
- Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
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Rodriguez-Merchan EC, Jimenez-Yuste V, Gomez-Cardero P, Alvarez-Roman M, Martin-Salces M, Rodriguez de la Rua A. Surgery in haemophilia patients with inhibitors, with special emphasis on orthopaedics: Madrid experience. Haemophilia 2011; 16:84-8. [PMID: 20536990 DOI: 10.1111/j.1365-2516.2010.02223.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We report on a series of 92 surgical procedures (90 patients). It includes 35 orthopaedic procedures (33 patients) and 57 non-orthopaedic procedures (57 patients). The orthopaedic procedures include 27 radiosynovectomies (minor surgery) and eight major orthopaedic procedures. The non-orthopaedic procedures include 52 minor interventions and five major procedures. The average age of patients was 34 years (range: 8-56), and the average follow-up time was 3 years (range: 1-6). Of the 92 surgical procedures, 42 were performed with activated prothrombin complex concentrates [factor eight inhibitor bypassing agent (FEIBA)] and 47 with recombinant-activated factor VIIa (rFVIIa; NovoSeven, Novo Nordisk, Bagsvaerd, Denmark). Regarding FEIBA treatment in minor surgery, the initial dose was 100 IU kg(-1). After 6 h, we continued with 50 IU kg(-1) every 12 h for at least 4 days (radiosynovectomies). In minor non-orthopaedic procedures, the dose was continued until day 14. In patients who underwent surgery with the haemostatic control achieved by means of rFVIIa, the initial dose of rFVIIa in minor procedures (both orthopaedic and non-orthopaedic) was 90-120 microg kg(-1). In postoperative days 1-5, the dose was 2-4 x 90-120 microg kg(-1) q3-6 h for 24 h. In major procedures (both orthopaedic and non-orthopaedic), the dose was 120 microg kg(-1) pre-operatively, 120 microg kg(-1) q 3 h day 2/day 3-5, and then 90-120 microg kg(-1) q 6 h until day 14. There were 87 good results, four fair results and one poor result. Our study has shown that haemophilic patients with inhibitors requiring surgery can undergo orthopaedic and non-orthopaedic procedures with a high expectation of success. In other words, surgery (orthopaedic and non-orthopaedic) is now possible in haemophilia patients with inhibitors, leading to an improved quality of life for these patients.
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Affiliation(s)
- E C Rodriguez-Merchan
- Department of Orthopaedics and Haemophilia Unit, La Paz University Hospital, Madrid, Spain.
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Quintana L, Paniagua JA, Gil-Contreras D, Jimenez-Yuste V, Torres A, Velasco F. Improving type 1 diabetes after treatment of immune thrombocytopenia with rituximab: killing two birds with one stone. Diabetes Care 2010; 33:e122. [PMID: 20805264 DOI: 10.2337/dc10-0959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Laura Quintana
- Servicio de Hematología Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Juan A. Paniagua
- Resistencia insulina, Metabolismo y Tejido adiposo, Servicio de Endocrinología y nutrición, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Daniel Gil-Contreras
- Resistencia insulina, Metabolismo y Tejido adiposo, Servicio de Endocrinología y nutrición, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Antonio Torres
- Servicio de Hematología Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Francisco Velasco
- Servicio de Hematología Hospital Universitario Reina Sofía, Córdoba, Spain
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Santagostino E, Morfini M, Auerswald GKH, Benson GM, Salek SZ, Lambert T, Salaj P, Jimenez-Yuste V, Ljung RCR. Paediatric haemophilia with inhibitors: existing management options, treatment gaps and unmet needs. Haemophilia 2010; 15:983-9. [PMID: 19712172 DOI: 10.1111/j.1365-2516.2009.01999.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Development of inhibitors is a severe complication of haemophilia posing many management challenges. While a long-term goal in inhibitor patients is eradication of inhibitors through immune tolerance induction, bypassing agents such as recombinant activated factor VII (rFVIIa) and activated prothrombin complex concentrate (aPCC) are essential for control of bleeding episodes. Paediatric patients with haemophilia and inhibitors are at particular risk of recurrent haemarthroses, and management of these patients should seek to avoid joint damage and support the child's full social and physical development. Current options for management of bleeding complications include on-demand treatment of acute bleeding episodes, secondary prophylaxis to avoid recurrent bleeds and surgery to treat affected joints. There is also a rationale for adopting prophylactic approaches to prevent bleeding in inhibitor patients, allowing this group similar opportunities for protection against arthropathy development as are given to non-inhibitor patients. This paper, based on a roundtable meeting of haematology experts at the first Zürich Haemophilia Forum in May 2008, reviews the current evidence supporting more intense and prophylactic approaches to manage bleeding risk in paediatric haemophilia patients with inhibitors, and highlights the need for investigations of primary prophylaxis in this vulnerable patient group, to support best long-term outcome.
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Affiliation(s)
- E Santagostino
- Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre, IRCCS Maggiore Hospital, Mangiagalli and Regina Elena Foundation, University of Milan, Milan, Italy.
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Martin-Salces M, Jimenez-Yuste V, Alvarez MT, Quintana M, Hernandez-Navarro F. Review: Factor XI Deficiency: Review and Management in Pregnant Women. Clin Appl Thromb Hemost 2008; 16:209-13. [DOI: 10.1177/1076029608327864] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Factor XI deficiency is a rare disease found predominantly in Ashkenazi Jews. There is a poor correlation between factor XI level and bleeding in patients with factor XI deficiency. Individuals with severe factor XI deficiency are usually at risk of excessive bleeding after surgery and injury, particularly when trauma involves tissues rich in fibrinolytic activity. Women with partial or severe deficiency are at risk of excessive uterine bleeding during labor. The unpredictable nature of factor XI deficiency complicates management during pregnancy and delivery. This review gives an overview of the management of pregnant women with factor XI deficiency.
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Affiliation(s)
- Monica Martin-Salces
- Haemophilia Unit, Haematology Department, Hospital Universitario La Paz, Madrid, Spain,
| | - Victor Jimenez-Yuste
- Haemophilia Unit, Haematology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Maria Teresa Alvarez
- Haemophilia Unit, Haematology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Manuel Quintana
- Haemophilia Unit, Haematology Department, Hospital Universitario La Paz, Madrid, Spain
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Hernandez-Navarro F, Quintana M, Jimenez-Yuste V, Alvarez MT, Fernandez-Morata R. Clinical efficacy in bleeding and surgery in von Willebrand patients treated with Fanhdi a highly purified, doubly inactivated FVIII/VWF concentrate. Haemophilia 2008; 14:963-7. [PMID: 18624696 DOI: 10.1111/j.1365-2516.2008.01784.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Therapy with factor VIII/von Willebrand factor (FVIII/VWF) concentrate is the mainstay therapy in patients with von Willebrand disease (VWD) unresponsive to desmopressin. There are several commercially available FVIII/VWF concentrates that have been tested in VWD patients. We retrospectively analized the clinical efficacy in bleeding episodes and surgery of a highly purified FVIII/VWF complex with two inactivation steps (Fanhdi) in VWD patients. Sixty patients were included in the study. Treatment schedule consisted of one or more doses (standard dose 40 IU/kg body weight of FVIII) of Fanhdi. One hundred and fifty bleeding episodes were treated. These were: 28 serious bleedings; 92 moderate and 30 mild. An excellent clinical efficacy in almost 95% of cases was observed. Fanhdi was administered during 66 surgical procedures (38 major and 28 minor) with an overall efficacy of 98%. Fanhdi a highly purified, doubly virus-inactivated FVIII/VWF concentrate, with a high content of active VWF and an excellent record of clinical safety, is a valid choice in treating VWD.
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Affiliation(s)
- F Hernandez-Navarro
- Centro de Coagulopatias, Haematology Department, Hospital Universitario La Paz, Madrid, Spain
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47
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Martin-Salces M, Jimenez-Yuste V, Alvarez MT, Quintana M, Hernandez-Navarro F. Management of the delivery in pregnant women with severe factor XI deficiency. Acta Haematol 2008; 119:154-5. [PMID: 18434707 DOI: 10.1159/000128044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2008] [Indexed: 11/19/2022]
Affiliation(s)
- M Martin-Salces
- Haemophilia Unit, Haematology Department, Hospital Universitario La Paz, Madrid, Spain.
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Abstract
We report on a series of 27 orthopaedic surgical procedures. It includes 20 radiosynoviortheses and seven major orthopaedic procedures, performed on 26 patients. The average age of patients was 36 years (range: 8-53) and the average follow-up time was 2.5 years (range:1-5). There were 23 good results and four fair. In the synoviorthesis group (20 patients, 20 synoviortheses) the average age was 13.5 years (range: 9-26) and the average follow-up was 4.5 years (range: 1-7). There were 19 good results and one fair. All synoviortheses were done with activated prothrombin complex concentrates (FEIBA), all the responses being good except in one case (which had the final fair result). The total dose of FEIBA used was 600 IU kg(-1,) except in a patient that had a haemorrhagic complication. In fact, he required a prolongation of treatment up to a total dose of 2000 IU kg(-1). In the group of major orthopaedic procedures, the average age of the six patients was 30.5 years (range: 11-53) and the average follow-up was 2.5 years (range: 1-5). There were six good results and one fair. Postoperative bleeding complications occurred in one of the seven major orthopaedic procedures performed (arterial pseudoaneurym after a total knee arthroplasty). Despite such complication, which had the final fair result, our study has shown that haemophilic patients with high inhibitor titres requiring orthopaedic surgery can undergo such procedures with a high expectation of success. In other words, orthopaedic surgery is now possible in haemophilia patients with high-titre inhibitors, leading to an improved quality of life for these patients.
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Affiliation(s)
- E C Rodriguez-Merchan
- Department of Orthopaedics and Haemophilia Unit, La Paz University Hospital, 28029-Madrid, Spain.
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Affiliation(s)
- Julio Delgado
- Department of Haematology, Hospital Universitario La Paz, Planta 6a Diagonal, Paseo de la Castellana 261, 28046 Madrid, Spain.
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Prim MP, De Diego JI, Jimenez-Yuste V, Sastre N, Rabanal I, Gavilan J. Analysis of the causes of immediate unanticipated bleeding after pediatric adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2003; 67:341-4. [PMID: 12663104 DOI: 10.1016/s0165-5876(02)00396-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To assess the incidence of unexpected postoperative bleeding in children undergoing adenoidectomy and/or tonsillectomy (T&A), and to investigate its possible undetected haematological causes. METHODS We prospectively collected all patients under 14 years of age with a normal preoperative haematologic work-up (activated partial thromboplastic time, prothrombin time, fibrinogen, and platelet count), who underwent surgery of adenoids and/or tonsils at our institution between January 1997 and November 2000. RESULTS There were 1516 cases that accomplished the inclusion criteria in the period of survey. Thirteen patients bled after surgery. This represents an incidence of 0.8% of immediate postoperative haemorrhage among the 1516 procedures analyzed. No statistical differences were found between bleeding and non-bleeding patients according to age, sex, and type of procedure (P>0.05). In 6 of the 13 bleeding patients (46.1%) an alteration of the coagulation system was subsequently found: 5 von Willebrand's disease, and 1 releasing thrombopathy. CONCLUSIONS The incidence of bleeding after adeno and/or tonsillectomy at our institution is comparable with series previously reported in the current medical literature. In nearly one half of the cases, undetected coagulation diseases (mainly von Willebrand's disease) are diagnosed after surgery in the haematological study.
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Affiliation(s)
- M P Prim
- Department of Otorhinolaryngology, La Paz Hospital, Autonomous University of Madrid, Spain.
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