Review article

Concomitant use of bypassing agents with emicizumab for people with haemophilia A and inhibitors undergoing surgery

Author
Jimenez-Juste V, Rodriguez-Merchan C, Matshushita T, Holme PA
Citation
Concomitant use of bypassing agents with emicizumab for people with haemophilia A and inhibitors undergoing surgery Victor Jiménez-Yuste, E. Carlos Rodríguez-Merchán, Tadashi Matsushita, Pål Andrè Holme First published: 14 May 2021 https://doi.org/10.1111/hae.14322
Date of Publication
Abstract

Introduction

Surgery in people with haemophilia and factor VIII inhibitors is typically managed with perioperative administration of haemostatic agents to prevent or control the occurrence of bleeding events. Practical experience of surgery in patients with inhibitors who are receiving treatment with emicizumab is growing; however, the novelty of the situation means that standardised guidelines are lacking with regard to the concomitant administration of haemostatic agents, including dose and laboratory monitoring.

 

Aim

To review approaches to haemostatic management during major and minor invasive procedures in patients with haemophilia A and inhibitors, and to provide recommendations for controlling bleeding events.

 

Methods

A search was conducted, limited to the past 4 years (January 2016-April 2020), pertaining to published evidence of surgery for patients receiving emicizumab. Publications identified from the search were manually reviewed to determine studies and case reports relevant for inclusion.

 

Results

Identified literature and practical experience of the authors were used to build a consensus of practical recommendations for the concomitant administration of haemostatic agents during the perioperative period for elective surgery in patients with inhibitors who are receiving emicizumab.

 

Conclusions

The current evidence base indicates that surgery can be successfully performed in patients with inhibitors who are receiving emicizumab and that bypassing agents can be used concomitantly. Data from prospective studies are required to further support recommendations for haemostatic management of surgery in patients receiving emicizumab.

This website is intended
for healthcare professionals (HCPs)
outside of the U.S.

Take me to www.novonordisk.com