ORTHOPAEDIC SURGERY IN TWO HAEMOPHILIC PATIENTS WITH HIGH-RESPONSE INHIBITORS
Abstract number: P-W-145
Quintana1 M., Bello1 I.F., Yuste1 V.J., Román1 M.A., Garrido1 J.R., Salces1 M.M., Navarro1 F.H.
1Congenital Coagulopathy Unit, Hospital Universitario La Paz, Madrid, Spain
How-to-cite Quintana M, Bello IF, Yuste VJ, Román MA, Garrido JR, Salces MM, Navarro FH. ORTHOPAEDIC SURGERY IN TWO HAEMOPHILIC PATIENTS WITH HIGH-RESPONSE INHIBITORS. J Thromb Haemost 2007; 5 Supplement 2: P-W-145
Introduction: The principal aim of this study is to evaluate the effectiveness and safety of bypassing agents on haemostatic control in orthopaedic surgery of haemophilic patients with high-response inhibitors.
Methods: Data was obtained from medical histories of two haemophilic patients with high-response inhibitors.Surgeries performed: Right and left knee arthroplasty in one of the patients and left ankle arthrodesis in the other case.Products used: Activated prothrombin complex concentrate (aPCC, FEIBA®) was used in the right knee arthroplasty and the left ankle arthrodesis. Activated recombinant FVII (rFVIIa, NovoSeven®) was used in the left knee arthroplasty.Laboratory tests:Tests prior to surgery were:platelet count per mm3, prothrombin activity (%), cephaline times (s), functional fibrinogen (mg/dL), dose of FVIII (chromogenic method), D-dimer and level of inhibitor (BU). Post-operative tests carried out every 48 hours were: Platelet count per mm3, prothrombin activity (%), cephaline times (s), functional fibrinogen(mg/dL) and D-dimer.Surgical procedures with aPCC: 100 UI/kg was administered prior tosurgery followed by the same dose 6 hours later and continuing with 50 UI/kg every 12 hours over a 15 day period. Thromboembolic prophylaxis was done with low-molecular-weight heparin.Surgical procedures with rFVIIa: 180 mcg/kg was administered prior to surgery followed by a dosage of 120 mcg/kg every 2 hours over a 24 hour period. Doses of 90 mcg/kg every 4 hours were administered over days 2 to 5 continuing with 90 mcg/kg every 6 hours until day 15. Thromboembolic prophylaxis was done with low-molecular-weight heparin.
Results: Neither hemorrhagic complications nor thromboembolic adverse events were observed. Patients begin joint rehabilitation on day 4° after surgery.
Conclusions: The use of bypassing agents for haemostatic control in orthopaedic surgery was effective with neither hemorrhagic complications nor thromboembolic adverse events.
To cite this abstract use the following format:
Journal of Thrombosis and Haemostasis 2007; Volume 5, Supplement 2: abstract number
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