OC 43.3 - Surgery in people with hemophilia A receiving emicizumab prophylaxis: real-world experience from a single French Reference Center of Hemophilia

Monday, June 26, 2023

15:15 – 15:30 ET

Room: 710B

Session Available As: On-Demand

Presenting Author(s)

Charlyne Brakta

Resident
Service Hématologie Biologique et Hémostase Clinique, Hôpital Cochin AP-HP.Centre - Université Paris Cité
Paris, Ile-de-France, France

Co-Author(s)

NS

Natalie Stieltjes

Doctor
Centre de Ressource et de Competences-Maladies Hemorragiques Constitutionnelles, Hopital Cochin APHP.Centre
Paris, Ile-de-France, France
SC

Sophie Combe

Doctor
Centre de Ressource et de Competences-Maladies Hemorragiques Constitutionnelles, Hopital Cochin APHP.Centre
Paris, Ile-de-France, France
NO

Nadra Ounnoughene

Doctor
Centre de Ressource et de Competences-Maladies Hemorragiques Constitutionnelles, Hopital Cochin APHP.Centre
Paris, Ile-de-France, France
JD

Jérôme Duchemin

Doctor
Service Hematologie Biologique et UF Hemostase Clinique, Hopital Cochin AP-HP.Centre - Universite Paris Cite
Paris, Ile-de-France, France
LC

Ladislas Capdevila

Doctor
Service Hematologie Biologique et UF Hemostase Clinique, Hopital Cochin AP-HP.Centre - Universite Paris Cite
Paris, Ile-de-France, France
LG

Laurie Goubeau

Resident
Service Hematologie Biologique et UF Hemostase Clinique, Hopital Cochin AP-HP. Centre -Universite Paris Cite
Paris, Ile-de-France, France
MF

Michaela Fontenay

Professor
Service Hematologie Biologique et UF Hemostase Clinique, Hopital Cochin AP-HP.Centre - Universite Paris Cite
Paris, Ile-de-France, France
VR

Valérie Roussel Robert

Doctor
Centre de Ressource et de Competences-Maladies Hemorragiques Constitutionnelles, Hopital Cochin APHP.Centre
Paris, Ile-de-France, France
VP

Valérie Proulle

Doctor
Service Hematologie Biologique et UF Hemostase Clinique, Hopital Cochin AP-HP.Centre - Universite Paris Cite
Paris, Ile-de-France, France

Background: Emicizumab has revolutionized prophylaxis in people with severe hemophilia A (PwHA). However, detailed management of surgical procedures in PwHA receiving emicizumab remain scarce in the literature. It may vary between hemophilia comprehensive centers due to the lack of evidence-based data. We report the 3-year experience from a single French Hemophilia Centre (CRC-MHC).

Aims: To describe the management and outcome of surgical procedures performed in PwHA receiving emicizumab prophylaxis at the CRC-MHC in Cochin hospital, Paris, France.

Methods: Data from procedures performed between 2020 and 2022 were collected retrospectively. Major bleeds were defined according to the ISTH Control of Anticoagulation Subcommittee recommendations1. Procedures were classified as major or minor as previously defined by Santagostino et al2. All patients gave their informed consent.

Results: Thirty-one procedures, 21 minor and 10 major, were performed in 16 PwHA receiving emicizumab for an average of 12 months (Table 1). Only 1/16 had an inhibitor (44 BU/mL at the time of surgery) and received rFVIIa treatment (13,746 g/kg) during 16 days for a knee prothesis with no bleeding or thrombotic complication. The other 15/16 PwHA received 51.5+/-74.6 or 770.9+/-602.2 (IU/kg) cumulative dose of rFVIII during 1.5+/-2.3 or 22.3+/-15.8 days for minor or major surgeries respectively. FVIII was monitored peri-operatively using bovine chromogenic assay to adjust dosage according to usual practice. A single bleeding complication (hematoma requiring surgery and transfusion) occurred 13 days after a knee prothesis during physical therapy.

Conclusion(s): We report one of the largest real-world experience of surgeries carried out in PwHA treated with emicizumab in a single French CRC-MHC. Hemostatic treatment approach, biological and clinical follow-up, as well as clinical outcomes do not seem to be different from those before emicizumab prophylaxis. Our data provide new evidence on the safety of performing surgeries in PwHA while on emicizumab prophylaxis.

Learning Objectives:

to describe the management of surgery in a severe hemophilia A patient on hemlibra
compare the surgical management of a severe hemophilia A patient on emicizumab between a French reference center and its pratice
visualize the impact of emicizumab treatment during surgeries in a real-life experience