Surgery in Patients With Hemophilia and Inhibitors: A Review of the Norwegian Experience With FEIBA

Surgical interventions in patients with hemophilia and inhibitors have often been postponed as long as possible due to difficulties in maintaining intra- and postoperative hemostatic control. Nonactivated and activated prothrombin complex concentrates have been successful in controlling acute bleeding in patients with inhibitors and have been useful in the surgical setting. At the Rikshospitalet–Radiumhospitalet University Hospital in Oslo, Norway, 17 minor and seven major surgical procedures were performed in nine patients with congenital hemophilia A and two patients with acquired hemophilia. Patients are generally treated according to the following dosing regimen, with changes made on a case-by-case basis: a preoperative loading dose of 100 U/kg of Factor Eight Inhibitor Bypassing Activity, Anti-Inhibitor Coagulant Complex, Vapor Heated (FEIBA; Baxter AG, Vienna, Austria), followed by 200 U/kg per day for 3 days. The dose is then tapered to 150 U/kg per day and subsequently to 100 U/kg per day. Hemostatic control was attained in all cases and only 1 major adverse event was observed. A 69-year-old patient experienced a non-ST-elevation myocardial infarction 3 days after undergoing a sigmoidectomy. He continued on FEIBA therapy and was stabilized with nitrates, opioid analgesia, and diuretics without clinical signs of heart failure.