From theory to practice: applying current clinical knowledge and treatment strategies to the care of hemophilia a patients with inhibitors.
Two bypassing agents are currently available to circumvent the need for factor FVIII in hemophilia A patients with inhibitors: the activated prothrombin complex FEIBA VH and recombinant activated factor VII (NovoSeven. Both products are highly effective in controlling bleeding in the presence of inhibitory alloantibodies, yet their hemostatic efficacy can be unpredictable. As the results of the FEIBA NovoSeven( Comparative (FENOC) study illustrate, patients may respond better to one bypassing agent than the other. Furthermore, guidelines from an expert panel reflect that responsiveness to bypassing therapy may change from one bleed to the next in the same patient and even from hour to hour during the course of a single bleeding event. These findings underscore the need to have both bypassing products available to treat bleeding episodes in inhibitor patients, to frequently evaluate the efficacy of hemostasis during the course of a bleeding event, and to switch products early if the response to treatment is unsatisfactory.
Gomperts
Edward D
ED
Children's Hospital Los Angeles, Division of Hematology/Oncology, 4650 Sunset Blvd., M/S #54, Los Angeles, California 90027, USA. egomperts@chla.usc.edu
Astermark
Jan
J
Gringeri
Alessandro
A
Teitel
Jerome
J
D019774:Blood Coagulation Factor Inhibitors / Q000276:immunology; D001779:Blood Coagulation Factors / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005169:Factor VIII / Q000276:immunology; D015942:Factor VIIa / Q000008:administration & dosage*; D006467:Hemophilia A / Q000188:drug therapy*; D006470:Hemorrhage / Q000188:drug therapy; D006801:Humans; D017410:Practice Guidelines as Topic; D011994:Recombinant Proteins / Q000008:administration & dosage
D019774:Blood Coagulation Factor Inhibitors; D001779:Blood Coagulation Factors; D011994:Recombinant Proteins; D005169:Factor VIII; C103587:recombinant FVIIa; C065655:anti-inhibitor coagulant complex; D015942:Factor VIIa