Management of people with haemophilia A undergoing surgery while receiving emicizumab prophylaxis: Real‐world experience from a large comprehensive treatment centre in the US. Issue 1 (27th November 2020)

• Record Type: Journal Article
• Authors: Lewandowska, Magdalena; Randall, Nicole; Bakeer, Nihal; Maahs, Jennifer; Sagar, Jeanne; Greist, Anne; Shapiro, Amy D.
• Is Part Of: Haemophilia. Volume 27:Issue 1(2021)
• Page Start: 90
• Page End: 99
• Publication Date: 2020-11-27
• Subjects: emicizumab -- haemophilia -- real‐world evidence -- surgery; Hemophilia -- Periodicals; 616.1572005
• DOI: 10.1111/hae.14212
• Languages: English
• ISSNs: 1351-8216

Abstract

Abstract: Introduction: Surgery is frequently required in persons with haemophilia A (PwHA). Emicizumab, a bispecific, humanized monoclonal antibody, bridges activated factor (F) IX and FX. Management of patients undergoing surgery while receiving emicizumab is of clinical interest due to paucity of data. Aim: Review real‐world experience of PwHA with/without FVIII inhibitors who required surgery while receiving emicizumab prophylaxis. Methods: Data regarding peri‐operative management, including type of surgery, haemostatic agent use and bleeding complications, were collected for PwHA receiving emicizumab undergoing surgery between 25/10/18 and 31/12/19 at the Indiana Hemophilia and Thrombosis Center. Analyses were exploratory and descriptive. Results: Twenty minor and five major surgeries were performed in 17 and five patients, respectively. Overall, 9/20 minor surgeries were planned to occur with emicizumab as the sole haemostatic agent; of these, four required additional coagulation factor (2 due to haematomas following port removals, 1 due to oozing at port removal site, 1 due to bleeding following squamous cell carcinoma removal). Three of the 11 minor surgeries with planned additional coagulation factor resulted in non‐major bleeds; all were safely managed with additional coagulation factor. All five major surgeries were planned with additional haemostatic agents; there was 1 bleed in a patient undergoing elbow synovectomy with nerve transposition, likely triggered by physical/occupational therapy. There were no major bleeds, thrombotic events or deaths. Conclusions: Additional haemostatic agent use is safe in PwHA undergoing surgery while receiving emicizumab. Additional data are needed to determine the optimal dosing/length of treatment of additional haemostatic agents to lower bleeding risk.