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Bypassing agents better controlled bleeding in acquired hemophilia A

Issue: June 25, 2012

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The use of bypassing agents to control bleeding in patients with acquired hemophilia A was effective in more than 90% of cases, according to data from the European Acquired Hemophilia Registry.

The multicenter, Web-based database reports the current patient management for patients with acquired hemophilia A. Various hemostatic agents currently are used to control bleeding in these patients, such as recombinant activated Factor VIIa, activated prothrombin complex concentrate (aPCC), Factor VIII, or Factor VIIa replacement therapy with concentrates of Factor VIIa released using 1-desamino-8-D-arginine-vasopressin (DDAVP). However, there is no consensus on the best agent for control.

In this study, considered to be the largest of its kind, the researchers assessed control of first bleeding episodes in 307 patients treated first line with one of the established agents.

Overall, 56.7% received recombinant Factor VIIa, 20.5% received aPCC, 18.2% received Factor VIII and 4.6% received DDAVP. Researchers compared the outcomes between the bypassing agents, recombinant Factor VIIa or apCC vs. Factor VIII or DDAVP.

Patients who were treated with a bypassing agent had significantly better bleeding control vs. those who were not (93.3% vs. 68.3%; P=.003). When the researchers examined outcomes between the two bypassing agents, they found that bleeding controls for both were about 93%.

“The data support caution in the use of bypassing agents in the typical acquired hemophilia A population due to an association with both arterial and venous thrombotic events,” the researchers wrote.

Eleven of the 307 treated patients reported a thrombotic event, including myocardial infarction, stroke and venous thromboembolism. Thrombotic events were reported in 2.9% of patients given recombinant Factor VIIa, 4.8% of patients given aPCC, and 0% of patients given Factor VIII or DDAVP.

References:

• Baudo F. Blood. 2012;doi:10.1182/blood-2012-02-048930.