Advanced

A systematic approach to controlling problem bleeds in patients with severe congenital haemophilia A and high-titre inhibitors

Teitel, J; Berntorp, Erik LU ; Collins, P; D'Oiron, R; Ewenstein, B; Gomperts, E; Goudemand, J; Gringeri, A; Key, N and Leissinger, C, et al. (2007) In Haemophilia 13(3). p.256-263
Abstract
The presence of inhibitory antibodies to clotting factors complicates the treatment of bleeding in haemophilia patients. For patients with high-titre inhibitors, bypassing agents are essential to haemostatic management. To determine optimal treatment practices, an international panel of physicians convened to develop a systematic treatment approach for problem bleeds (i.e. bleeds that are unresponsive to initial therapy with a single agent within a reasonable amount of time) in haemophilia patients with inhibitors. AIM: The goal of this panel was to develop a consensus algorithm that would aid physicians in considering a variety of treatment approaches to optimize patient care by preventing extensive therapy with inadequate treatments that... (More)
The presence of inhibitory antibodies to clotting factors complicates the treatment of bleeding in haemophilia patients. For patients with high-titre inhibitors, bypassing agents are essential to haemostatic management. To determine optimal treatment practices, an international panel of physicians convened to develop a systematic treatment approach for problem bleeds (i.e. bleeds that are unresponsive to initial therapy with a single agent within a reasonable amount of time) in haemophilia patients with inhibitors. AIM: The goal of this panel was to develop a consensus algorithm that would aid physicians in considering a variety of treatment approaches to optimize patient care by preventing extensive therapy with inadequate treatments that may lead to suboptimal patient outcomes and unnecessary costs. METHODS: Consensus opinions were analyzed for clinical preferences at different time periods, depending on patient response to treatment. Decision-making points were defined based on the type of bleed: every 8-12 h for the first 24 h, then every 24 h thereafter for limb-threatening bleeds; every 2-4 h for 2-7 days for life-threatening bleeds. RESULTS: The resultant consensus guidelines provide a generalized methodology to guide the treatment of problem bleeds in patients with severe haemophilia A and inhibitors, and emphasize changing treatment at the first sign of an inadequate haemostatic response. The treatment algorithms apply to both paediatric and adult patients, although the differences between the two groups were reviewed. CONCLUSION: These guidelines are focused on optimising the timing of treatment decisions, which may lead to faster responses and improved outcomes. (Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
management, inhibitors, haemophilia, guidelines, consensus, bleeding
in
Haemophilia
volume
13
issue
3
pages
256 - 263
publisher
Federation of European Neuroscience Societies and Blackwell Publishing Ltd
external identifiers
  • pmid:17498074
  • scopus:34248594449
ISSN
1351-8216
DOI
10.1111/j.1365-2516.2007.01449.x
language
English
LU publication?
yes
id
88ac1930-1133-4581-babf-af6cf870bd36 (old id 1139392)
date added to LUP
2008-08-20 13:36:54
date last changed
2017-09-17 05:27:15
@article{88ac1930-1133-4581-babf-af6cf870bd36,
  abstract     = {The presence of inhibitory antibodies to clotting factors complicates the treatment of bleeding in haemophilia patients. For patients with high-titre inhibitors, bypassing agents are essential to haemostatic management. To determine optimal treatment practices, an international panel of physicians convened to develop a systematic treatment approach for problem bleeds (i.e. bleeds that are unresponsive to initial therapy with a single agent within a reasonable amount of time) in haemophilia patients with inhibitors. AIM: The goal of this panel was to develop a consensus algorithm that would aid physicians in considering a variety of treatment approaches to optimize patient care by preventing extensive therapy with inadequate treatments that may lead to suboptimal patient outcomes and unnecessary costs. METHODS: Consensus opinions were analyzed for clinical preferences at different time periods, depending on patient response to treatment. Decision-making points were defined based on the type of bleed: every 8-12 h for the first 24 h, then every 24 h thereafter for limb-threatening bleeds; every 2-4 h for 2-7 days for life-threatening bleeds. RESULTS: The resultant consensus guidelines provide a generalized methodology to guide the treatment of problem bleeds in patients with severe haemophilia A and inhibitors, and emphasize changing treatment at the first sign of an inadequate haemostatic response. The treatment algorithms apply to both paediatric and adult patients, although the differences between the two groups were reviewed. CONCLUSION: These guidelines are focused on optimising the timing of treatment decisions, which may lead to faster responses and improved outcomes.},
  author       = {Teitel, J and Berntorp, Erik and Collins, P and D'Oiron, R and Ewenstein, B and Gomperts, E and Goudemand, J and Gringeri, A and Key, N and Leissinger, C and Monahan, P and Young, G},
  issn         = {1351-8216},
  keyword      = {management,inhibitors,haemophilia,guidelines,consensus,bleeding},
  language     = {eng},
  number       = {3},
  pages        = {256--263},
  publisher    = {Federation of European Neuroscience Societies and Blackwell Publishing Ltd},
  series       = {Haemophilia},
  title        = {A systematic approach to controlling problem bleeds in patients with severe congenital haemophilia A and high-titre inhibitors},
  url          = {http://dx.doi.org/10.1111/j.1365-2516.2007.01449.x},
  volume       = {13},
  year         = {2007},
}