New approaches to using FEIBA in the treatment of inhibitor patients.
Managing hemophilia becomes particularly difficult in patients with inhibitory antibodies, especially in those requiring surgery or with refractory bleeding events. Equally challenging are those patients who develop autoantibodies against factor VIII (FVIII) in the absence of a prior history of FVIII deficiency (acquired hemophilia). Physicians seeking both short- and long-term treatment strategies for bleeding events must often rely on FVIII-bypassing agents such as activated prothrombin complex concentrate (e.g., factor eight bypassing activity [FEIBA VH, Baxter BioScience, Westlake Village, CA]) or recombinant factor VIIa (rFVIIa [NovoSeven, NovoNordisk, Bagsvaerd, Denmark]). Surgical procedures in patients with inhibitors present a considerable challenge, from both a risk-benefit and a cost-benefit aspect. Hemostasis is difficult to achieve in these patients and new treatment options are being explored. Similarly challenging are refractory bleeds, the management of which is likely to benefit from a systematic treatment approach.
Berntorp
Erik
E
Malmö University Hospital, Malmö, Sweden. erik.berntorp@med.lu.se
Gringeri
Alessandro
A
Leissinger
Cindy
C
Négrier
Claude
C
Key
Nigel
N
D001323:Autoantibodies / Q000737:chemistry; D019774:Blood Coagulation Factor Inhibitors / Q000627:therapeutic use; D001779:Blood Coagulation Factors / Q000737:chemistry / Q000627:therapeutic use*; D005169:Factor VIII / Q000276:immunology / Q000627:therapeutic use; D006405:Hematology / Q000639:trends*; D006467:Hemophilia A / Q000628:therapy*; D006801:Humans
D001323:Autoantibodies; D019774:Blood Coagulation Factor Inhibitors; D001779:Blood Coagulation Factors; D005169:Factor VIII; C065655:anti-inhibitor coagulant complex