Activated prothrombin complex concentrate (FEIBA) treatment during surgery in patients with inhibitors to FVIII/IX

Haemophilia. 2004 Mar;10(2):174-8. doi: 10.1046/j.1365-2516.2003.00857.x.

Abstract

Non-activated and activated prothrombin complex concentrates (PCC/aPCC) have been used successfully to treat bleeds in haemophilia patients with inhibitors, but most physicians do not consider these products as effective as factor VIII/IX (FVIII/IX) concentrates in non-inhibitor patients. Thus, surgical procedures in inhibitor patients have been performed reluctantly. We have performed 14 minor and five major surgical and invasive diagnostic procedures in eight patients with congenital haemophilia A and inhibitors and in two patients with acquired haemophilia. When a loading dose of 100 U kg-1 of FEIBA was given followed by 200 U kg-1 day-1 in three divided doses every 8 h for 3 days, and then, when the daily dose was tapered to 100-150 U kg-1, no severe or unexpected bleeding complications were observed. However, one adverse event was observed. A 69-year-old man who suffered a myocardial infarction the third postoperative day following sigmoidectomy was managed safely with opiate analgesia, nitrates and diuretics, and the continued use of FEIBA(R).

MeSH terms

  • Adult
  • Aged
  • Blood Coagulation Factor Inhibitors / metabolism*
  • Blood Coagulation Factors / administration & dosage*
  • Blood Coagulation Factors / adverse effects
  • Blood Loss, Surgical / prevention & control
  • Child
  • Coagulants / administration & dosage*
  • Coagulants / adverse effects
  • Factor IX / antagonists & inhibitors*
  • Factor IX / therapeutic use
  • Factor VIII / antagonists & inhibitors*
  • Factor VIII / therapeutic use
  • Hemophilia A / blood
  • Hemophilia A / complications*
  • Hemophilia A / drug therapy
  • Hemostasis, Surgical
  • Humans
  • Intraoperative Complications / prevention & control*
  • Middle Aged
  • Treatment Outcome

Substances

  • Blood Coagulation Factor Inhibitors
  • Blood Coagulation Factors
  • Coagulants
  • Factor VIII
  • Factor IX
  • anti-inhibitor coagulant complex