Major surgery for a gastric cancer in a haemophilic with high inhibitor titre successfully performed by the use of recombinant FVIIa

Citation
A. Rocino et al., Major surgery for a gastric cancer in a haemophilic with high inhibitor titre successfully performed by the use of recombinant FVIIa, HAEMOPHILIA, 5(6), 1999, pp. 441-444
Citations number
14
Categorie Soggetti
Hematology
Journal title
HAEMOPHILIA
ISSN journal
13518216 → ACNP
Volume
5
Issue
6
Year of publication
1999
Pages
441 - 444
Database
ISI
SICI code
1351-8216(199911)5:6<441:MSFAGC>2.0.ZU;2-P
Abstract
A total gastrectomy with omentectomy and resection of the distal oesophagus in a 69-year-old haemophilia A patient with high inhibitor of 128 Bethesda units is described. Surgery was successfully performed after infusion of 1 12 mu g kg(-1) bw of recombinant FVIIa. Ninety-two mu g kg(-1) were given t hereafter at time intervals of 2 h until 12 h, then every 3 h until 24 h, a nd every 4 h until 48 h after surgery. Doses were gradually reduced in the following days and finally discontinued on day 28 after surgery. The comple te treatment schedule required the administration of a total of 708 mg of r ecombinant FVIIa. Using this approach, we observed normal haemostasis, and there were no signs of excessive postoperative bleeding or wound haematoma. No clinical side-effects or evidence of systemic activation of coagulation occurred during the treatment. As judged from the clinical course of this major surgery, recombinant FVIIa appears to be highly efficacious and safe and should be used as first line treatment in high titre inhibitor patients with cross-reactivity to porcine factor VIII, undergoing surgery.