Coagulation Department
Contributions
Type: Publication Only
Background
Acquired and congenital haemophilia with inhibitor against FVIII or FIX are usually managed with bypassing agents, such as recombinant factor VIIa (rFVIIa) and activated prothrombin complex concentrates (APCC).
To be able to evaluate and predict the clinical effects of treatment with bypassing agents, global coagulation assays could be useful monitoring tools.
One of the currently leading candidate methods for this purpose is thromboelastography/ rotational thromboelastometry (TEG/ROTEM ).
Aims
Our purpose is to evaluate the changes in ROTEM parameters during treatment with bypassing agents and its correlation with the clinical effect.
Methods
In this retrospective study 11 haemophilia patients were included (age 5-85 years). Four (n:4) were patients with congenital severe haemophilia A with inhibitors and seven (n:7) were patients with acquired haemophilia A. Recorded total 15 bleeding episodes, acute or associated to surgical procedures and all of the patients treated with APCC. Monitoring of global hemostasis was performed with ROTEM assay, before and after bypassing agent administration.
Results
Excellent and good haemostatic effect was demonstrated in 87% of patients. One patient had adverse effect complicated with thrombosis. According to ROTEM analysis in NATEM the average of clotting time (CT) before and after APCC administration was 2110 sec and 888 sec respectively. Furthermore the clot stability was evaluated with maximum clotting firmness (MCF) parameter and that was 11 mm and 62 mm before and after APCC administration respectively.
Summary
The results of this single-centre report demonstrates, in a limited number of patients, improvement in ROTEM parameters (CT and MCF in NATEM) after APCC administration. In the most of the cases these results accompanied with good or excellent clinical response (87%) in bypassing agent treatment.
According to our data the ROTEM method could be a useful monitoring tool to predict the efficacy of treatment with bypassing agents in haemophilia patients with inhibitors. Undoubtedly further studies should be performed with adequate number of patients in order to reinforce our conclusion.
Keyword(s): Hemophilia, Inhibitor, Thrombelastograph
Type: Publication Only
Background
Acquired and congenital haemophilia with inhibitor against FVIII or FIX are usually managed with bypassing agents, such as recombinant factor VIIa (rFVIIa) and activated prothrombin complex concentrates (APCC).
To be able to evaluate and predict the clinical effects of treatment with bypassing agents, global coagulation assays could be useful monitoring tools.
One of the currently leading candidate methods for this purpose is thromboelastography/ rotational thromboelastometry (TEG/ROTEM ).
Aims
Our purpose is to evaluate the changes in ROTEM parameters during treatment with bypassing agents and its correlation with the clinical effect.
Methods
In this retrospective study 11 haemophilia patients were included (age 5-85 years). Four (n:4) were patients with congenital severe haemophilia A with inhibitors and seven (n:7) were patients with acquired haemophilia A. Recorded total 15 bleeding episodes, acute or associated to surgical procedures and all of the patients treated with APCC. Monitoring of global hemostasis was performed with ROTEM assay, before and after bypassing agent administration.
Results
Excellent and good haemostatic effect was demonstrated in 87% of patients. One patient had adverse effect complicated with thrombosis. According to ROTEM analysis in NATEM the average of clotting time (CT) before and after APCC administration was 2110 sec and 888 sec respectively. Furthermore the clot stability was evaluated with maximum clotting firmness (MCF) parameter and that was 11 mm and 62 mm before and after APCC administration respectively.
Summary
The results of this single-centre report demonstrates, in a limited number of patients, improvement in ROTEM parameters (CT and MCF in NATEM) after APCC administration. In the most of the cases these results accompanied with good or excellent clinical response (87%) in bypassing agent treatment.
According to our data the ROTEM method could be a useful monitoring tool to predict the efficacy of treatment with bypassing agents in haemophilia patients with inhibitors. Undoubtedly further studies should be performed with adequate number of patients in order to reinforce our conclusion.
Keyword(s): Hemophilia, Inhibitor, Thrombelastograph