Management of bleeding and invasive procedures in haemophilia A patients with inhibitor treated with emicizumab (Hemlibra®): Proposals from the French network on inherited bleeding disorders (MHEMO), the French Reference Centre on Haemophilia, in collaboration with the French Working Group on Perioperative Haemostasis (GIHP)

• Published in: Haemophilia : the official journal of the World Federation of Hemophilia 2019-09, Vol.25 (5), p.731-737
• Main Authors: Susen, Sophie, Gruel, Yves, Godier, Anne, Harroche, Annie, Chambost, Herve, Lasne, Dominique, Rauch, Antoine, Roullet, Stephanie, Fontana, Pierre, Goudemand, Jenny, de Maistre, Emmanuel, Chamouard, Valerie, Wibaut, Bénédicte, Albaladejo, Pierre, Négrier, Claude
• Format: Article
• Language: English
• Subjects: Antibodies, Bispecific - pharmacology; Antibodies, Bispecific - therapeutic use; Antibodies, Monoclonal, Humanized - pharmacology; Antibodies, Monoclonal, Humanized - therapeutic use; Bleeding; Collaboration; Disease management; emergency; emicizumab; France; haemophilia; Hemophilia; Hemophilia A - drug therapy; Hemostasis; Humans; inhibitor; invasive procedures; Life Sciences; proposals; Working groups
• ISSN: 1351-8216; 1365-2516
• DOI: 10.1111/hae.13817

Introduction Emicizumab (Hemlibra®) recently became available and requires an adaptation for managing bleeding, suspected bleeding and emergency or scheduled invasive procedures in haemophilia A patients with inhibitor. This implicates a multidisciplinary approach and redaction of recommendations for care that must be regularly adapted to the available data. Aim The following text aims to provide a guide for the management of people with haemophilia A with inhibitor treated with emicizumab in case of bleeding or invasives procedures. Methods The French network on inherited bleeding disorders (MHEMO), the French Reference Centre on Haemophilia (CRH), in collaboration with the French Working Group on Perioperative Haemostasis (GIHP) have been working together to make proposals for the management of these situations. Results Haemostatic treatment and other medications should be given stepwise, according to the severity and location of the bleeding or the risk of bleeding of the procedure as well as the haemostatic response obtained at each step in order to ensure an optimal benefit/risk ratio. Conclusion The lack of data means that it is only possible to issue proposals rather than recommendations.