Major surgery for a gastric cancer in a haemophilic with high inhibitor titre successfully performed by the use of recombinant FVIIa

• Published in: Haemophilia : the official journal of the World Federation of Hemophilia 1999-11, Vol.5 (6), p.441-444
• Main Authors: Rocino, A, Carola, A, Papa, M L, Parisi, V, Cremona, F, Miraglia, E, De Biasi, R
• Format: Article
• Language: English
• Subjects: Aged; Factor VIIa - administration & dosage; Factor VIIa - immunology; haemophilia A; Hemophilia A - drug therapy; Hemophilia A - immunology; Hemophilia A - surgery; Hemostasis - drug effects; high inhibitor titre; Humans; Isoantigens - adverse effects; Isoantigens - blood; major surgery; Male; Recombinant Proteins - administration & dosage; Recombinant Proteins - immunology; rFVIIa; Stomach Neoplasms - complications; Stomach Neoplasms - surgery
• ISSN: 1351-8216; 1365-2516
• DOI: 10.1046/j.1365-2516.1999.00351.x

A total gastrectomy with omentectomy and resection of the distal oesophagus in a 69‐year‐old haemophilia A patient with high inhibitor of 128 Bethesda units is described. Surgery was successfully performed after infusion of 112 μg kg–1 bw of recombinant FVIIa. Ninety‐two μg kg–1 were given thereafter at time intervals of 2 h until 12 h, then every 3 h until 24 h, and every 4 h until 48 h after surgery. Doses were gradually reduced in the following days and finally discontinued on day 28 after surgery. The complete treatment schedule required the administration of a total of 708 mg of recombinant FVIIa. Using this approach, we observed normal haemostasis, and there were no signs of excessive postoperative bleeding or wound haematoma. No clinical side‐effects or evidence of systemic activation of coagulation occurred during the treatment. As judged from the clinical course of this major surgery, recombinant FVIIa appears to be highly efficacious and safe and should be used as first line treatment in high titre inhibitor patients with cross‐reactivity to porcine factor VIII, undergoing surgery.