Options for treating acute bleeds in addition to bypassing agents: extracorporeal immunoadsorption, FVIII/FIX, desmopressin and antifibrinolytics.
Inhibitor patients do not always respond satisfactorily to treatment with bypassing agents, and options to the standard practice are sometimes needed. Temporary inhibitor removal may be achieved using extracorporeal immunoadsorption. This technique uses a column system including either protein A or antihuman IgG. Immunoadsorption may be used as part of an immune tolerance protocol, or in the case of acute bleeds or prior to surgery, thus rendering the patient more responsive to ordinary replacement therapy with factor VIII or factor IX. Desmopressin is a valuable haemostatic agent in many situations and can be especially recommended in mild haemophilia complicated by an inhibitor. Antifibrinolytics are often administered as an adjunct therapy to the treatment protocol and have also been reported to have a direct anti-inhibitor effect.
Berntorp
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Malmö Center for Thrombosis and Hemostasis, Malmö University Hospital, Malmö, Sweden. erik.berntorp@med.lu.se
D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D003029:Coagulants / Q000627:therapeutic use*; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D005112:Extracorporeal Circulation / Q000379:methods; D005164:Factor IX / Q000627:therapeutic use*; D005169:Factor VIII / Q000627:therapeutic use*; D006467:Hemophilia A / Q000628:therapy*; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D007163:Immunosorbent Techniques; D013205:Staphylococcal Protein A / Q000627:therapeutic use
D000933:Antifibrinolytic Agents; D003029:Coagulants; D013205:Staphylococcal Protein A; D005169:Factor VIII; D005164:Factor IX; D003894:Deamino Arginine Vasopressin