title: Hemostatic treatment using factor VIII concentrates for neutralizing high-responding inhibitors prior to CVAD insertion for immune-tolerance induction therapy.
abstract: We have utilized high-dose factor VIII (FVIII) concentrates in 4 hemophilia A patients with inhibitors prior to surgery for the insertion of a central venous access device. In total, 3 patients out of 4 had high responding inhibitors. Dosing algorithms for this type of therapy have not been previously validated and established. We devised an effective formula to calculate the initial dose required to neutralize the inhibitors, although some of the patients demonstrated a lower recovery of FVIII than expected. An anamnestic inhibitor response was evident in 3 cases, but overall our strategy provided a reliable hemostatic effect for at least 4 days after surgery. In addition, our protocol appeared to be more cost-effective than FVIII bypass therapy. The financial saving in 1 case for the initial 3 days was estimated to be approximately US$49 122. Our results demonstrated that high-dose FVIII therapy provided clinically effective and economically viable results even in high responders.
authors: Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan. mshibata@naramed-u.ac.jp
authors: Masaru
authors: M
authors: Shibata
authors: Takashi
authors: T
authors: Nakagawa
authors: Shinji
authors: S
authors: Akioka
authors: John C
authors: JC
authors: Giddings
authors: Hiromichi
authors: H
authors: Kanehiro
authors: Tomoko
authors: T
authors: Matsumoto
authors: Kenichi
authors: K
authors: Ogiwara
authors: Koji
authors: K
authors: Yada
authors: Midori
authors: M
authors: Shima
mesh_terms: D019774:Blood Coagulation Factor Inhibitors / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D005169:Factor VIII / Q000008:administration & dosage* / Q000191:economics; D006467:Hemophilia A / Q000097:blood* / Q000188:drug therapy* / Q000191:economics; D006490:Hemostatics / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D007223:Infant; D008297:Male
chemical_list: D019774:Blood Coagulation Factor Inhibitors; D006490:Hemostatics; C078147:F8 protein, human; D005169:Factor VIII