RECOMBINANT FACTOR VIIA IN CONTINUOUS-INFUSION DURING CENTRAL LINE INSERTION IN A CHILD WITH FACTOR-VIII HIGH-TITER INHIBITOR

Recombinant factor VIIa (rFVIIa) is a recently added new tool for the treatment of haemophilia patients with inhibitors. A major drawback in the use of rFVIIa is its short half-life, which necessitates frequent bolus injections, Thus the use of rFVIIa in continuous infusion appea rs to be a good alternative. We describe the use of rFVIIa, administer ed by continuous infusion with a minipump during the insertion of a ce ntral venous catheter in a child with a high-titre factor VIII inhibit or. rFVIIa was administered as an intravenous bolus (90 mu g kg(-1) [4 .5 kIU kg(-1)]), 1 h prior to central line insertion, after which the continuous infusion was immediately started for 5 days. The infusion r ate was based on the clearance obtained from a previous pharmacokineti c study. Effective haemostasis and normal healing of surgical incision s were achieved after central line insertion. No local thrombophlebiti s nor evidence of generalized activation of the coagulation cascade wa s observed. Single-dose pharmacokinetic parameter values were clearanc e (Cl) 34.6 mt h(-1) kg(-1), volume of distribution (Vd) 40.6 mL kg(-1 ) and mean residence time (MRT) 1.17 h. The recovery was 2.27% U-1 kg( -1). rFVIIa showed a monophasic decay. Cl during continuous infusion w as 23.4 +/- 6.9 mt h(-1) kg(-1) The administration of rFVIIa by contin uous infusion is effective, safe and more convenient when compared to other clotting factors. Moreover, continuous infusion provides signifi cant economic savings (77% decrease in rFVIIa requirements).