Introduction: Continuous infusion (CI) of FVIII used for the intensive treatment of haemophilia has proven to be a haemostatically effective mode of factor replacement. However, there is a wide variation in the technique and treatment protocols employed and recent anectodal reports of inhibitor development after CI in mild/moderate haemophilia have raised concerns. Methods: Current practice in the use of CI was surveyed in 22 European haemophilia comprehensive care centres. Treatment efficacy and inhibitor development after CI were evaluated. Results: CI is used in 13/22 (57%) of the centres surveyed. A total of 1072 CI procedures were performed in 868 haemophilia A patients (779 severe; 89 moderate /mild), including 126 in 111 children. All centres use CI for surgery, five centres also for major bleeds and six center in patients with inhibitors. All centres use concentrated FVIII solutions. Syringe pumps, portable minipumps, or both delivery devices are used in four, five and four centres respectively. Ten centres employ the adjusted dose CI and three fixed rate CI protocols. Preprocedure pharmacokinetics testing was performed in six centres, and intervals for exchange of infusion sets are 12, 24 and up to 72 h in three, six and two centres, respectively. The treatment with CI (duration 2–15 days) is regularly followed with factor bolus injections (BI) in 12/13 centers. The wide range of initial doses of FVIII (3.0–5.0IU/kg/h) reflects the different FVIII level targets in days 1–3 (0.6–1.0 IU/mL.CI was rated as haemostatically effective by all centres. Only ten of 868 (1.5%) patients developed inhibitor after intensive treatment with continuous infusion, three (0.4%) with severe hemophilia, seven (7.9%) mild. Conclusion: CI is an effective and safe treatment mode for haemophilia. The inhibitor formation seen in mild haemophilia after intensive treatment for surgery (either CI or BI) requires thorough investigation with respect to all confounding risk factors
Continuous infusion practice in 22 haemophilia comprehensive care centres in 16 European countries / A. Batorova, P. Holme, A. Gringeri, K. Fijnvandraat, M. Richards, C. Hermans, C. Altisent, M. Lopez Fernàndez. - In: JOURNAL OF THROMBOSIS AND HAEMOSTASIS. - ISSN 1538-7933. - 7:Suppl. 2(2009 Jul), pp. 509-509. ((Intervento presentato al 22. convegno Congress of the International Society of Thrombosis and Haemostasis tenutosi a Boston, USA nel 1999 [10.1111/j.1538-7836.2009.03473_2.x].
Continuous infusion practice in 22 haemophilia comprehensive care centres in 16 European countries
A. Gringeri;
2009
Abstract
Introduction: Continuous infusion (CI) of FVIII used for the intensive treatment of haemophilia has proven to be a haemostatically effective mode of factor replacement. However, there is a wide variation in the technique and treatment protocols employed and recent anectodal reports of inhibitor development after CI in mild/moderate haemophilia have raised concerns. Methods: Current practice in the use of CI was surveyed in 22 European haemophilia comprehensive care centres. Treatment efficacy and inhibitor development after CI were evaluated. Results: CI is used in 13/22 (57%) of the centres surveyed. A total of 1072 CI procedures were performed in 868 haemophilia A patients (779 severe; 89 moderate /mild), including 126 in 111 children. All centres use CI for surgery, five centres also for major bleeds and six center in patients with inhibitors. All centres use concentrated FVIII solutions. Syringe pumps, portable minipumps, or both delivery devices are used in four, five and four centres respectively. Ten centres employ the adjusted dose CI and three fixed rate CI protocols. Preprocedure pharmacokinetics testing was performed in six centres, and intervals for exchange of infusion sets are 12, 24 and up to 72 h in three, six and two centres, respectively. The treatment with CI (duration 2–15 days) is regularly followed with factor bolus injections (BI) in 12/13 centers. The wide range of initial doses of FVIII (3.0–5.0IU/kg/h) reflects the different FVIII level targets in days 1–3 (0.6–1.0 IU/mL.CI was rated as haemostatically effective by all centres. Only ten of 868 (1.5%) patients developed inhibitor after intensive treatment with continuous infusion, three (0.4%) with severe hemophilia, seven (7.9%) mild. Conclusion: CI is an effective and safe treatment mode for haemophilia. The inhibitor formation seen in mild haemophilia after intensive treatment for surgery (either CI or BI) requires thorough investigation with respect to all confounding risk factors
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