Management of perioperative hemostasis in a severe hemophilia A patient with inhibitors on emicizumab using global hemostasis assays
| Autor: | Guy Young, Clara Lana Yukhtman, Jennifer Donkin, Elizabeth Marquez-Casas, Hande Kizilocak, Jeanie Lee |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Emicizumab
medicine.medical_specialty congenital hereditary and neonatal diseases and abnormalities Standard of care medicine.diagnostic_test business.industry lcsh:RC633-647.5 Hematology Perioperative lcsh:Diseases of the blood and blood-forming organs Severe hemophilia A Thromboelastography Hemostasis medicine Intensive care medicine business Thrombin generation test |
| Zdroj: | Therapeutic Advances in Hematology, Vol 10 (2019) |
| ISSN: | 2040-6215 |
| Popis: | Background:Patients with severe hemophilia A and inhibitors are at risk of bleeding during invasive procedures. The standard of care for preventing perioperative bleeding has been replacement therapy with FVIII concentrates or for patients with high-titer inhibitors, bypassing agents. However, there is no consensus on the appropriate management of surgery in patients receiving the novel agent emicizumab. The aim of this study was to demonstrate a case of a patient on emicizumab undergoing major surgery with bypassing agents with preoperative use of the thrombin generation assay (TGA) and thromboelastography (TEG).Methods:We report a patient with hemophilia A with inhibitors who had undergone a total knee replacement while on emicizumab combined with a bypassing agent. We utilized TEG and TGA to determine which bypassing agent to choose as well as to inform about the ideal dose.Results:We elected to use recombinant FVIIa as a bypassing agent for the surgery based upon the TGA results.Conclusion:The TGA can be utilized to support decision-making in patients on emicizumab undergoing major surgery to both predict efficacy and potentially minimize the risk of thrombotic events. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|