[Continuous infusion of recombinant activated factor VII during and after elbow arthroplasty in a hemophilia A patient with inhibitors].
Recombinant activated factor VII (rFVIIa) is a recently added new agent for the treatment of hemophiliacs with inhibitors. A major drawback to the use of rFVIIa is its short half-life, necessitating frequent and intermittent bolus injections. Continuous infusion of rFVIIa has been reported as a feasible, convenient, safe and cost-effective alternative to intermittent bolus injections. We report the use of continuous rFVIIa infusion during and after left elbow arthroplasty in a hemophiliac with a high titer of inhibitor to factor VIII. rFVIIa was administered as a bolus injection (100 micrograms/kg) at the start of the operation, after which continuous infusion (10-30 micrograms/kg/h) was immediately started and continued for 6 days. Tranexamic acid (50 mg/kg/day, p.o.) was also administered as an antifibrinolytic treatment. Laboratory monitoring of hemostatic efficacy was performed in this case using prothrombin time and the thrombelastogram. Finally, effective intra- and postoperative hemostasis and normal healing of the surgical incisions were achieved, except for local thrombophlebitis. Although the optimal maintenance or target level of rFVIIa has been a matter of debate, we consider continuous infusion of rFVIIa to be a feasible, convenient, safe and cost-effective alternative to intermittent bolus injections.
Nakamura
Masanori
M
Division of Hematology and Oncology, Shizuoka Children's Hospital.
Terashima
Keita
K
Takashima
Yoshifumi
Y
Amano
Koji
K
Horikoshi
Yasuo
Y
Mimaya
Jun-ichi
J
D000906:Antibodies / Q000097:blood; D001178:Arthroplasty; D004550:Elbow / Q000601:surgery*; D015942:Factor VIIa / Q000008:administration & dosage*; D006467:Hemophilia A / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007430:Intraoperative Care; D008297:Male; D011994:Recombinant Proteins / Q000008:administration & dosage
D000906:Antibodies; D011994:Recombinant Proteins; D015942:Factor VIIa