Arthropathy is prevalent in patients with
haemophilia and inhibitors and is a major source of
pain and disability, significantly reducing quality of life. Recombinant
activated factor VII (
rFVIIa;
NovoSeven is one of the treatments available for acute life-threatening
bleeding episodes in
haemophilia patients with inhibitors. It has also been used successfully in a range of orthopaedic
surgical procedures in these patients. This is a review of published data on elective orthopaedic procedures in
haemophilia patients with inhibitors under cover of
rFVIIa from January 2002 to November 2006. Articles were retrieved from MEDLINE using specified search parameters. Twelve articles covering a total of 80 orthopaedic procedures were identified. In the vast majority of cases,
rFVIIa provided safe and effective haemostatic cover during orthopaedic surgery with no
bleeding complications. There was variation in the administered dose, although the majority of patients were treated with 90 mug kg(-1) bolus followed by either continuous infusion or bolus infusion. Of those cases reporting
bleeding complications, most were considered to be related to an inadequate amount of
rFVIIa. The cumulative experience presented here suggests that
rFVIIa is safe and effective for providing adequate haemostatic cover for
haemophilia patients with inhibitors undergoing orthopaedic surgery. The optimal dosing regimen and mode of administration has yet to be identified. Further controlled trials are needed to confirm these experiences.