title: Kreuth IV: European consensus proposals for treatment of haemophilia with coagulation factor concentrates.
abstract: BACKGROUND
  This report summarizes recommendations relating to haemophilia therapy arising from discussions among experts from 36 European countries during the 'Kreuth IV' meeting in May 2016.
  
  
  OBJECTIVE
  The objective of the meeting was for experts in the field of haemophilia from across Europe to draft resolutions regarding current issues relating to the treatment of haemophilia.
  
  
  RESULTS
  Hospitals providing clinical care for people with haemophilia and related disorders are strongly recommended to seek formal designation as either European Haemophilia Treatment Centres (EHTC) or European Haemophilia Comprehensive Care Centres (EHCCC). There should be agreed national protocols or guidelines on management of the ageing patient with haemophilia. The minimum consumption of factor VIII and IX concentrate in any country should be 4 IU and 0.5 IU per capita of general population respectively. Treatment for hepatitis C with direct-acting antiviral agents should be provided to all people with haemophilia on a priority basis. Genotype analysis should be offered to all patients with severe haemophilia. Genetic counselling, when given, should encompass the recommendation that genetic relatives of the affected person be advised to seek genetic counselling. People with inhibitors should have access to bypassing agents, immune tolerance and elective surgery. National or regional tenders for factor concentrates are encouraged. Outcome data including health related quality of life should be collected. Treatment with extended half-life factors should be individualized and protection against bleeding should be improved by increasing trough levels. Steps should be taken to understand and minimize the risk of inhibitor development.
  
  
  CONCLUSIONS
  It is hoped that these recommendations will help to foster equity of haemophilia care throughout Europe.
authors.affiliation: European Haemophilia Consortium, Brussels, Belgium.|University of Oxford, Oxford, UK.
authors.forename: P L F
authors.identifier: http://orcid.org/0000-0001-5408-3719
authors.initials: PLF
authors.lastname: Giangrande
authors.affiliation: Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Peyvandi
authors.affiliation: European Haemophilia Consortium, Brussels, Belgium.|Trinity College, Dublin, Ireland.
authors.forename: B
authors.initials: B
authors.lastname: O'Mahony
authors.affiliation: European Directorate for the Quality of Medicines and HealthCare (EDQM), Council of Europe, Strasbourg, France.
authors.forename: M-E
authors.initials: ME
authors.lastname: Behr-Gross
authors.affiliation: Paul-Ehrlich-Institut, Langen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hilger
authors.affiliation: Rudolf-Marx-Foundation, University of Munich, Munich, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Schramm
authors.affiliation: Angelo Bianchi Bonomi Hemophilia and Thrombosis Centre, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: P M
authors.initials: PM
authors.lastname: Mannucci
mesh_terms: D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D005060:Europe; D006467:Hemophilia A / Q000188:drug therapy*; D006801:Humans
chemical_list: D001779:Blood Coagulation Factors
keywords: factor IX; factor VIII; guidelines; haemophilia; inhibitors; prophylaxis