Combined use of antifibrinolytics and activated prothrombin complex concentrate (aPCC) is not related to thromboembolic events in patients with acquired haemophilia A: data from FAIR Registry
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Antifibrinolytics combined with aPCC are not routinely administered to patients with acquired hemophilia A due to increased thrombotic risk. This association normalizes clot stability, and improves the efficacy of therapy, but can increase the risk of severe side effects. Due to these premises it has always raised doubts and perplexities in the clinics. We now report the data of the “FEIBA® on acquired haemophilia A Italian Registry (FAIR Registry)”, a retrospective-prospective study that included 56 patients. This is the first study that assessed the clinical response of the combination of aPCC and antifibrinolytic agents in patients with acquired haemophilia A. A total of 101 acute bleeds were treated with aPCC. Antifibrinolytic agents were used in the treatment of 39.6% of total bleeds, based on both, a clinical assessment and an evaluation of bleeding. Twenty-five of the 30 patients (57.1%) treated with antifibrinolytic drugs showed serious co-morbidity. Among them, 40% presented severe cardiovascular diseases. All bleeds treated with combined therapy had a shorter duration of treatment (mean reduction 16.3%). All the treated patients presented a good tolerability and no arterial or venous thromboembolic events were reported. In our retrospective registry the combination of antifibrinolytics and aPCC appears safe and effective in the treatment of patients with AHA, especially in the case of severe and life-threatening bleeding, but this hypothesis needs to be confirmed in adequate, larger clinical trials.
KeywordsAcquired haemophilia A Activated prothrombin complex concentrate Antifibrinolytics Thromboembolic risk
All of the authors meet the International Committee of Medical Journal Editors criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval of the version to be published. The FAIR Study Group: Siragusa S and Napolitano M (Hematology Department, Center of Hemorrhagic and Thrombotic Diseases, University of Palermo); Federici AB (Hematology and Transfusion Medicine Departement, Luigi Sacco Hospital, Milan); Mameli L (Center of Coagulation Diseases, SS Annunziata Hospital, Sassari); Giuffrida G (Hemathology Department, VE Ferrarotto and S.Bambino University Hospital, Catania); Falanga A (Transfusion Medicine and Immunohematology Department, Giovanni XXIII Hospital, Bergamo); Lodigiani C (Medicine Department, Humanitas Clinical Institute, Rozzano); Santoro RC (Center of Hemorrhagic and Thrombotic Diseases, Pugliese-Ciaccio Hospital, Catanzaro).
This work did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. This medical and statistical writing assistance for the FAIR registry was supported by Baxalta-Shire.
Compliance with ethical standards
Conflict of interest
All authors have read and understood JTT policy on declaration of interests and declare that they have no competing interests.
All procedures performed in this study involving human partecipants were in accordance with the ethical standards of the institutional and/or national research and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
All patients enrolled in our retrospective-prospective registry accepted to participate in the study signing the informed consent as requested by Ethical Committees. In the case of retrospective patients who had died before the start of collection data the informed consent was signed by a family member.
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