Table 2.
Summary of management and outcomes of minor and major surgical interventions in PwHA on emicizumab prophylaxis.
| PwHA Case # | Age at Time of Surgery, Years | Inhibitor Status (Yes/No) |
Procedure/Surgery Type (Elective/Urgent) | Time on EMI, Days † | Preoperative Factor Dose rFVIIa (µg/kg) rFVIII (IU/kg) | Factor Consumption (Days) | Hospitalization (Days) |
Bleeding Episode * (Yes/No) | Overall Outcome |
|---|---|---|---|---|---|---|---|---|---|
| Minor surgical procedures | |||||||||
| 1 | 55 | No | Cataract removal (elective) | 308 | 70 IU/kg | 70 IU/kg (1 day) | 0 | No | Visual acuity improved. |
| 2 | 66 | No | Cystoscopic lithotripsy (elective) | 230 | 50 IU/kg | 285 IU/kg (10 days) | 3 | Yes | Bladder stones were successfully removed. |
| 3 | 32 | No | Percutaneous coronary intervention with stent placement (urgent) ‡ | 362 | 27 IU/kg (1st PCI); 17 IU/kg (2nd PCI) | 130 IU/kg (4 days) | 6 | No | Switching to FVIII prophylaxis while on DAPT. |
| Major surgical procedures | |||||||||
| 4 | 50 | Yes | Osteosynthesis after spiral femur fracture (urgent) | 26 (end of induction) | 94 µg/kg | 5.08 mg/kg (14 days) | 18 | Yes | Successful osteosynthesis. |
| 51 | Yes | Osteosynthesis of pseudoarthrosis (elective) | 279 | 90 µg/kg | 6.54 mg/kg (14 days) | 13 | No | ||
| 5 | 56 | No | Necrectomy of chronic osteomyelitis with re-arthrodesis (elective) | 274 | 40 IU/kg | 386 IU/kg (14 days) | 22 | No | Walks with the help of a leg prosthesis. |
| 56 | No | Below-knee amputation (elective) | 608 | 37 IU/kg | 381 IU/kg (14 days) | 15 | No | ||
| 6 | 56 | No | Bilateral osteosynthesis of the tibia and fibula (urgent) | 596 | 53 IU/kg | 506 IU/kg (14 days) | 36 (one hospitalization) | Yes | Survived, remained disabled. |
| 56 | No | Below-knee amputation (urgent) | 599 | 26 IU/kg | No | ||||
| 7 | 51 | No | External ventricular drainage after intraventricular hemorrhage (urgent) | 448 | 53 IU/kg | 320 IU/kg (14 days) | 58 (one hospitalization) | No | Physical and cognitive improvement. Successful osteosynthesis. Switch to FVIII prophylaxis. |
| 51 | No | Osteosynthesis after hip fracture (urgent) | 478 | 27 IU/kg | 253 IU/kg (14 days) | No | |||
| 8 | 52 | No | Total right knee arthroplasty (elective) | 567 | 50 IU/kg | 442 IU/kg (14 days) | 16 | No | Better mobility, less pain. |
† All PwHA were on emicizumab (3 mg/kg) prophylaxis once every two weeks. ‡ PwHA experienced a STEMI after one year on emicizumab. * Bleeding during hospitalization. EMI, emicizumab; IU, international unit; rFVIII, recombinant factor VIII; rFVIIa, recombinant activated factor FVII; PCI, percutaneous coronary intervention; PwHA, person with hemophilia A; STEMI, ST segment elevation myocardial infarction.