Continuous infusion in haemophilia: current practice in Europe
ABSTRACT Continuous infusion (CI) of factor VIII (FVIII) is an effective method for replacement therapy in haemophilia. Recently, concerns have been raised regarding association of CI with the development of inhibitors. The aim of this study was to gain information on the current practices in Europe regarding CI and the true inhibitor incidence after this mode of therapy. In a cross sectional study performed in 22 Comprehensive Care Centres (CCCs), we evaluated CI techniques, treatment protocols, efficacy, safety and complications of CI including inhibitors. Thirteen (59%) CCCs reported a total of 1079 CI treatments, given peri-operatively or for major bleeds, in 742 patients. Most centres used 'adjusted dose' CI aimed at median target FVIII level of 0.8 IU mL(-1). CI was haemostatically very effective with a low incidence of complications: median incidence of postoperative bleeding was 1.8%, six centres observed phlebitis in 2-11% of CI treatments. Only nine (1.2%) patients developed inhibitors (0.45% of 659 severe and 7.2% of 83 mild haemophilia patients). Additional analysis of inhibitor patients revealed several confounding factors (low number of prior FVIII exposure days, high steady-state factor levels during CI, high-risk genotype). In this unprecedentedly large cohort, CI treatment appears to be an effective and safe treatment that does not increase the risk of inhibitor development in patients with severe haemophilia. Thus, previous small case series reports suggesting that CI may increase inhibitors cannot be confirmed. Inhibitor risk in mild haemophilia could not be evaluated as the influence of other, potentially confounding, risk factors could not be excluded.
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ABSTRACT: Continuous infusion of factor VIII (FVIII) is a more cost-effective method for treating hemophilia A than intermittent bolus injection. However, there is currently no specific data in Korea about the progress of in vitro FVIII coagulant activity (FVIII:C) after reconstitution from its lyophilized form. Three commercial FVIII concentrate products (two recombinant FVIII and one plasma-derived) were used. In vitro FVIII:C was measured at 0, 2, 4, 6, and 8 hours following reconstitution in both the indoor light-exposed and light-shielded groups. For the three drugs, in vitro FVIII:C decreased over the 8 hours following reconstitution (P<0.001). The decline of FVIII:C was linear (P<0.001). In vitro FVIII:C for the indoor light-exposed groups was 95.3±1.9% and 90.6±2.5% after 4 and 8 hours following reconstitution, respectively, compared to baseline activity. In the light-shielded group, FVIII:C was 95.4±1.1% and 90.9±1.7% of the baseline activity after 4 and 8 hours, respectively. There was no statistical difference between FVIII:C in the indoor light-exposed and light-shielded groups (P=0.849). In vitro FVIII:C decreased after reconstitution, but activity was maintained at over 90% of the baseline value during 8 hours. Exposure to indoor light did not accelerate the loss of FVIII:C over the experimental time. This result indicates that CI with FVIII is available in 8-hour intervals, with no indoor light-exposure precautions needed.12/2014; 49(4):265-9. DOI:10.5045/br.2014.49.4.265
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ABSTRACT: INTRODUCTION.Ruptured abdominal aortic aneurysm (AAA) is a life-threatening condition with an overall mortality rate of 65%. Massive haemorrhage requires infusion of fluids that do not contain clotting factors which develops dilutional coagulopathy. Rotational thrombelastometry (ROTEM) permits differential diagnosis of the underlying pathomechanism of coagulopathy. PCC showed much efficiency in the treatment of intraoperative massive bleeding . CASE REPORT. A 79-year-old man was addmited to Vascular Surgery Department, Clinical center in Nis as an emergency with the symptoms of AAA rupture. After resuscitation he was trasported to the operation room (Hgb: 45 g/L, HCT: 15%, BP: 80/40 mmHg). Massive infusion of crystalloids, colloids and plasma expanders kept the patient hemodinamically stable but led to dilutional coagulopathy. Transfusion of platelets, cryoprecipitate and fresh-frozen plasma (FFP) were provided together with tranexamic acid. Total blood loss during the surgery was 5L and 1.85L was returned to the patient by autotransfusion. Coagulation status was checked by ROTEM. The greatest deviation was found in the INTEM, CFT=3374s and α=12o (Picture 1) and in the EXTEM, CFT=169s and α=66o (Picture 2). After the infusion of 500IJ PCC, the results of INTEM went back to normal ranges (CFT=71s, α=76o) (Picture 3), as well as the results of EXTEM (CFT=71s, α=77o) (Picture 4). After the extensive operation, the patient spend 5 days in the Intensive care unit and was discharget from hospital after 26 days. CONCLUSION. PCC improves coagulation stability faster and more efficient than FFP without the risk of transfusion, volume load and infectious complications.XII SERBIAN CONGRESS OF ANESTHESIOLOGISTS&INTESIVISTS, Belgrade; 10/2014
Conference Paper: ROLE OF BIOMARKERS IN CARDIAC RISK ASSESSMENT FOR NON-CARDIAC SURGERYXII SERBIAN CONGRESS OF ANESTHESIOLOGISTS&INTESIVISTS, Belgrade; 10/2014