Activated prothrombin complex concentrate (FEIBA®) for the treatment and prevention of bleeding in patients with acquired haemophilia: A sequential study. Issue 6 (December 2015)

• Record Type: Journal Article
• Authors: Zanon, Ezio; Milan, Marta; Gamba, Gabriella; Ambaglio, Chiara; Saggiorato, Graziella; Spiezia, Luca; Montani, Nadia; Prandoni, Paolo
• Is Part Of: Thrombosis research. Volume 136:Issue 6(2015)
• Page Start: 1299
• Page End: 1302
• Publication Date: 2015-12
• Subjects: Acquired haemophilia -- Activated prothrombin complex concentrate -- Prophylaxis -- Bleeding; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2015.10.032
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Despite anti-haemorrhagic therapy with proper doses of activated prothrombin complex concentrate (aPCC, Feiba®), patients with acquired haemophilia A (AHA) have a considerable risk of recurrent bleeding complications. Evidence in support of the benefit-to-risk ratio of prevention strategies with the use of lower doses of aPCC following the end of the initial treatment period is scarce and inconclusive. We report our experience in the management of 18 consecutive patients with AHA admitted to two Haemophilia centres in Italy. We managed the first 11 according to current guidelines (e.g., with conventional aPCC doses until bleeding resolution). Then, we decided to prolong the treatment beyond bleeding resolution with lower doses of the same concentrate (short-term prophylaxis) in the 7 additional patients. In these patients, the treatment was continued for as long as the titre of FVIII inhibitor was found to decrease by at least 50% when compared to the baseline one. We observed six relapses of bleeding in patients in whom aPCC was confined to the treatment of the qualifying bleeding episode, and none in patients to whom lower doses were administered until the pre-specified decrease in the titre of FVIII inhibitor was achieved. No patients experienced thrombotic complications during the study period. Prolonging the treatment with lower doses of aPCC beyond the initial phase in patients with AHA in whom the titre of FVIII inhibitor is still high is likely to safely prevent further bleeding complications. Highlights: No standardized protocols on the use of aPCC for the treatment of patients with AHA are available. Based on the results of a recent international registry, 25% of AHA patients are prone to relapse into bleeding. The extension of administration of aPCC treatment in lower doses beyond the resolution of the acute bleeding has the potential decrease the risk of bleeding relapses in patients with AHA. No adverse events were reported using this strategy.