Five patients with severe
haemophilia A and high responding inhibitors underwent laparoscopic or open surgery on the digestive tract (appendicectomy,
cholecystectomy, partial
colectomy, or haemorrhoidectomy) with recombinant
activated factor VII (
rFVIIa) prophylaxis.
rFVIIa was administered at a dose of 92-127 mug/kg prior to surgery and then every 2 h for 18-56 h before increasing the dosing interval. One patient was switched to a continuous infusion after 48 h of
rFVIIa boluses.
rFVIIa treatment lasted between 5 and 14 days in four patients, with good or excellent efficacy (total dose, 3.13-9.28 mg/kg). The fifth patient, who underwent surgery for prolapsed haemorrhoids, bled on day 6 and day 10 after the procedure, despite a satisfactory prothrombin time and
factor VII coagulant level. The
rFVIIa dose regimen was increased after the second
bleeding episode, then the
bleeding rapidly ceased after this modification to the treatment regimen. The total dose of
rFVIIa used was 12.65 mg/kg, and treatment lasted 17 days.
Antifibrinolytic treatment was used concomitantly in all five patients. Clinical and
biological tolerability was excellent, and no increase in the anti-
factor VIII inhibitor titre was observed. These results suggest that
rFVIIa prophylaxis is effective in
haemophilia A patients with
factor VIII inhibitors who are undergoing elective or emergency intestinal surgery. Further studies are required to optimize the dose regimen and treatment period according to the surgical indication and technique.