Perioperative replacement therapy in haemophilia B: An appeal to “B” more precise

• Published in: Haemophilia : the official journal of the World Federation of Hemophilia Vol. 24; no. 4; pp. 611 - 618
• Main Authors: Hazendonk, H. C. A. M., Preijers, T., Liesner, R., Chowdary, P., Hart, D., Keeling, D., Driessens, M. H. E., Laros‐van Gorkom, B. A. P., Meer, F. J. M., Meijer, K., Fijnvandraat, K., Leebeek, F. W. G., Mathôt, R. A. A., Collins, P. W., Cnossen, M. H.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.07.2018
• Subjects: Bleeding; Blood transfusion; Body weight; clotting factor concentrates; Coagulation factor IX; Coagulation factors; Erythrocytes; Factor IX deficiency; haemophilia B; haemostasis; Hemophilia; individualized treatment; Muscles; Patients; perioperative replacement therapy; Surgery; surgical procedures; clotting factor concentrates; surgical procedures; individualized treatment; haemophilia B; haemostasis; perioperative replacement therapy
• ISSN: 1351-8216; 1365-2516
• DOI: 10.1111/hae.13469

Introduction Haemophilia B is caused by a deficiency of coagulation factor IX (FIX) and characterized by bleeding in muscles and joints. In the perioperative setting, patients are treated with FIX replacement therapy to secure haemostasis. Targeting of specified FIX levels is challenging and requires frequent monitoring and adjustment of therapy. Aim To evaluate perioperative management in haemophilia B, including monitoring of FIX infusions and observed FIX levels, whereby predictors of low and high FIX levels were assessed. Methods In this international multicentre study, haemophilia B patients with FIX < 0.05 IU mL−1 undergoing elective, minor or major surgical procedures between 2000 and 2015 were included. Data were collected on patient, surgical and treatment characteristics. Observed FIX levels were compared to target levels as recommended by guidelines. Results A total of 255 surgical procedures were performed in 118 patients (median age 40 years, median body weight 79 kg). Sixty percent of FIX levels within 24 hours of surgery were below target with a median difference of 0.22 IU mL−1 [IQR 0.12‐0.36]; while >6 days after surgery, 59% of FIX levels were above target with a median difference of 0.19 IU mL−1 [IQR 0.10‐0.39]. Clinically relevant bleeding complications (necessity of a second surgical intervention or red blood cell transfusion) occurred in 7 procedures (2.7%). Conclusion This study demonstrates that targeting of FIX levels in the perioperative setting is complex and suboptimal, but although this bleeding is minimal. Alternative dosing strategies taking patient and surgical characteristics as well as pharmacokinetic principles into account may help to optimize and individualize treatment.