Treatment of Severe Hemophilia A with Factor VIII Inhibitors Undergoing an Invasive Procedure
Clinical Scenario
This protocol applies to patients with severe hemophilia A who have factor VIII inhibitors and are undergoing an invasive procedure that requires treatment with bypassing agents.
Treatment Approach
Management is centred on bypassing agent therapy. The specific agent selected depends on the patient's current prophylaxis regimen — a key clinical distinction that determines which option is appropriate.
The complete evidence-based regimen, including agent selection and all clinical considerations, is available in the full structured protocol.
References
DOI: 10.1016/j.jtha.2024.05.026
- In individuals with severe hemophilia A with inhibitors undergoing invasive procedures requiring treatment with bypassing agents, the ISTH Hemophilia Guideline Panel suggests either recombinant FVIIa (eptacog alfa) or activated prothrombin complex concentrate (conditional recommendation, based on very low–certainty evidence ⨁◯◯◯).
- In patients who are on prophylaxis with emicizumab, recombinant FVIIa is preferred due to potential thrombotic complications with concomitant use of emicizumab and activated prothrombin complex concentrate.
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