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
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.