[Continuous Infusion of Recombinant Activated Factor VII During and After Elbow Arthroplasty in a Hemophilia A Patient with Inhibitors]

Recombinant activated factor VII (rFVIIa) is a recently added new agent for the treatment of hemophiliacs with inhibitors. A major drawback to the use of rFVIIa is its short half-life, necessitating frequent and intermittent bolus injections. Continuous infusion of rFVIIa has been reported as a feasible, convenient, safe and cost-effective alternative to intermittent bolus injections. We report the use of continuous rFVIIa infusion during and after left elbow arthroplasty in a hemophiliac with a high titer of inhibitor to factor VIII. rFVIIa was administered as a bolus injection (100 micrograms/kg) at the start of the operation, after which continuous infusion (10-30 micrograms/kg/h) was immediately started and continued for 6 days. Tranexamic acid (50 mg/kg/day, p.o.) was also administered as an antifibrinolytic treatment. Laboratory monitoring of hemostatic efficacy was performed in this case using prothrombin time and the thrombelastogram. Finally, effective intra- and postoperative hemostasis and normal healing of the surgical incisions were achieved, except for local thrombophlebitis. Although the optimal maintenance or target level of rFVIIa has been a matter of debate, we consider continuous infusion of rFVIIa to be a feasible, convenient, safe and cost-effective alternative to intermittent bolus injections.