Abstract Number: LPB0117
Meeting: ISTH 2021 Congress
Theme: Hemophilia and Rare Bleeding Disorders » Novel Biotherapeutics in Hemophilia
Background: The association of emicizumab and recombinant activated FVII (rFVIIa) has been recently proposed for surgical procedures in persons with Haemophilia A (PWHA) and inhibitors. However, only isolated experiences of major orthopaedic surgery have been to date reported.
Aims: This is the report about the first experience on major orthopaedic surgery with several procedures at a single Haemophilia centre in PWHA and inhibitors.
Methods: Between 2018 and 2020, three PWHA and high titer inhibitors underwent 5 major orthopaedic surgeries: one above-the-knee amputation and a Total Knee Arthroplasty (TKA) in a 56-years old subject; a Total Hip Arthroplasty (THA) in a 59-years old patient; a partial revision knee arthroplasty (rTKA) and an acetabular revision on a failed THA in a 49-years old subject. Visual Analogic Scale (VAS), Haemophilic Joint Health Score (HJHS), and a postoperative radiologic study were used for patients’ evaluation. The prophylaxis was performed by a regimen of weekly emicizumab and bolus infusions of rFVIIa[c1] (preoperative bolus of 90 μg/kg before anaesthesia, followed by infusions for 2 weeks after surgery).
Results: All patients were successfully treated by a single surgeon, without any intra- or post-operative complications and with an effective bleeding control. No signs of hypercoagulabity or thrombotic microangiopathy were observed, clinically and by using specific laboratory markers (schistocytes, platelet count, LDH, and D-dimer). All patients were regularly rehabilitated at the same hospital. The mean follow-up is 15.7 months (range: 5-24). No adverse event was recorded at the latest evaluation. All patients reported satisfaction, pain reduction, and improved VAS and HJHS scores.
Conclusions: Major orthopaedic surgery conducted by emicizumab and rFVIIa in PWHA and inhibitors showed excellent clinical outcomes and an effective bleeding control. A larger number of procedures and longer follow-up periods are required to validate such protocol.
To cite this abstract in AMA style:
Carulli C, Linari S, Pieri L, Castaman G. The Association of Emicizumab and rFVIIa for Major Orthopaedic Surgery [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/the-association-of-emicizumab-and-rfviia-for-major-orthopaedic-surgery/. Accessed March 22, 2024.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/the-association-of-emicizumab-and-rfviia-for-major-orthopaedic-surgery/