title: Sequential treatment with bolus and continuous infusion of recombinant factor VIIa for hip arthroplasty in a patient with haemophilia A and inhibitor.
abstract: We describe a total arthroplasty of the hip in a 40-year-old male patient with haemophilia A and a high-titre inhibitor to factor VIII, treated with rFVIIa. The patient received sequential therapy first as bolus in the early postoperative phase in order to obtain appropriate haemostasis and then as continuous infusion with lower doses to avoid frequent episodes of bleeding without a higher consumption of product. After an initial dose of 150 micro g kg-1 for the first five days after surgery, we used bolus doses of 120-90 micro g kg-1 every 2.5-3 h, achieving plasma FVII:C levels above 40 U mL-1. We then continued with continuous infusion at decreasing doses 15-7 micro g kg-1 h-1 for 12 days (FVII:C 19-7 U mL-1). There were no bleeding complications nor signs of clotting activity. The rehabilitation programme was continued without prophylactic treatment. The total consumption of rFVIIa was 6.3 mg kg-1, implying a saving of at least 30% of the product with respect to previous publications.
authors.affiliation: Haemophilia Unit, University Hospital Virgen del Rocio, Seville, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Perez
authors.forename: R L
authors.initials: RL
authors.lastname: Martinez
authors.forename: A
authors.initials: A
authors.lastname: Piñero
authors.forename: R
authors.initials: R
authors.lastname: Sosa
mesh_terms: D000328:Adult; D019644:Arthroplasty, Replacement, Hip; D004334:Drug Administration Schedule; D005167:Factor VII / Q000627:therapeutic use*; D005169:Factor VIII / Q000037:antagonists & inhibitors*; D015942:Factor VIIa; D006467:Hemophilia A / Q000188:drug therapy*; D006801:Humans; D008297:Male; D019990:Perioperative Care / Q000379:methods; D011994:Recombinant Proteins / Q000627:therapeutic use*
chemical_list: D011994:Recombinant Proteins; D005167:Factor VII; D005169:Factor VIII; C103587:recombinant FVIIa; D015942:Factor VIIa