Continuous infusions of B domain-truncated recombinant factor VIII, turoctocog alfa, for orthopedic surgery in severe hemophilia A: first case report
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Continuous infusions (CI) of factor (F)VIII are preferable to the conventional bolus injections for the maintenance of consistent FVIII levels during surgery in patients with severe hemophilia A. A third generation, B domain-truncated recombinant FVIII (turoctocog alfa, Novo Nordisk, NovoEight®), was approved for clinical use in 2014. The hemostatic efficacy and safety of bolus injections of turoctocog alfa in patients undergoing surgery have been reported, but no reports on CI therapy have been published. We describe a 43-year-old patient with severe hemophilia A who required arthroscopic synovectomy of the right elbow and arthrodesis of the right ankle. He was treated with a bolus injection of turoctocog alfa (36 IU/kg) immediately before operation, followed by CI (infusion rate; 2.9 IU/kg/h) to maintain FVIII activity > 80 IU/dl throughout the perioperative period. Surgery was completed successfully with uncomplicated hemostatic control. CIs were continued until post-operative day (POD) 4. Further bolus injections were given from POD5. No anti-FVIII inhibitor has been detected post-operation. This case provides important information on CI therapy using turoctocog alfa during surgery for patients with severe hemophilia A.
KeywordsTuroctocog alfa Hemophilia A Continuous infusion Surgery Hemostatic management
We would like to thank for Drs. Yasuaki Shida and Koji Yada for the clinical support.
TM designed the research, analyzed the data, and drafted initial manuscript; NK interpreted the data, revised the manuscript, and approved the final version to be published; OK, KR, TA, NY, IY, and TY provided clinical support; SM supervised the manuscript.
Compliance with ethical standards
Conflict of interest
Takeyama M, Ogiwara K, Inagaki Y, and Tanaka Y have received funding for their research from Novo Nordisk. Nogami K has received funding for his research from Novo Nordisk, Bayer, Shire, Bioverative, Chugai, and KAKETSUKEN. Shima M has received funding for his research from Novo Nordisk, Bayer, Shire, Pfizer, Bioverative, Chugai, and KAKETSUKEN. Kobayashi R, Taniguchi A, and Nakanishi Y have no conflicts of interest.
- 7.Lentz SR, Misgav M, Ozelo M, Salek SZ, Veljkovic D, Recht M, et al. Results from a large multinational clinical trial (guardian1) using prophylactic treatment with turoctocog alfa in adolescent and adult patients with severe haemophilia A: safety and efficacy. Haemophilia. 2013;19:691–7.CrossRefPubMedGoogle Scholar
- 8.Lentz SR, Cerqueira M, Janic D, Kempton C, Matytsina I, Misgav M, et al. Interim results from a large multinational extension trial (guardian 2) using turoctocog alfa for prophylaxis and treatment of bleeding in patients with severe haemophilia A. Haemophilia. 2016;22:e445–9.CrossRefPubMedGoogle Scholar
- 9.Kulkarni R, Karim FA, Glamocanin S, Janic D, Vdovin V, Ozelo M, et al. Results from a large multinational clinical trial (guardian 3) using prophylactic treatment with turoctocog alfa in paediatric patients with severe haemophilia A: safety, efficacy and pharmacokinetics. Haemophilia. 2013;19:698–705.CrossRefPubMedGoogle Scholar
- 10.Meijer K, Rauchensteiner S, Santagostino E, Platokouki H, Schutgens RE, Brunn M, et al. Continuous infusion of recombinant factor VIII formulated with sucrose in surgery: non-interventional, observational study in patients with severe haemophilia A. Haemophilia. 2015;21:e19–25.CrossRefPubMedGoogle Scholar