Continuous infusion factor replacement in haemophilia B during and after cardiac surgery: the better choice?.
Continuous infusion factor replacement in haemophilia B during and after cardiac surgery: the better choice?.
- 2020
A 57-year-old man with mild haemophilia B was admitted for coronary artery bypass graft surgery. His factor IX (FIX) activity was 15% on admission. Our goal was to maintain his FIX activity at 80%-100% for post-op days (PODs) 0-3, and at 60%-80% for PODs 4-14. Preoperatively, the patient was given recombinant FIX (rFIX) bolus using the formula:Dosage needed=%(desired FIX level-current level of FIX)xweight (kg)x1.3. This increased his activity to 100%. One IU of rFIX increased FIX activity by 0.8%; the half-life of rFIX is 18-24 hours. The rFIX infusion was started intraoperatively and continued after surgery to maintain target FIX activity. He was discharged on POD 9 on rFIX bolus dosing of 5000 IU every 12 hours for an additional 5 days. Using continuous factor infusion, we managed to decrease the amount rFIX used by >60% while maintaining steady state FIX activity level. Copyright (c) BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.
English
1757-790X
10.1136/bcr-2020-235859 [doi] 13/11/e235859 [pii] PMC7705362 [pmc]
*Coronary Artery Bypass
*Factor IX/ad [Administration & Dosage]
*Hemophilia B/dt [Drug Therapy]
Factor IX/me [Metabolism]
Hemophilia B/bl [Blood]
Hemophilia B/co [Complications]
Humans
Infusions, Intravenous
Male
Middle Aged
Recombinant Proteins/ad [Administration & Dosage]
MedStar Washington Hospital Center
Washington Cancer Institute
Medicine/Internal Medicine
Journal Article
A 57-year-old man with mild haemophilia B was admitted for coronary artery bypass graft surgery. His factor IX (FIX) activity was 15% on admission. Our goal was to maintain his FIX activity at 80%-100% for post-op days (PODs) 0-3, and at 60%-80% for PODs 4-14. Preoperatively, the patient was given recombinant FIX (rFIX) bolus using the formula:Dosage needed=%(desired FIX level-current level of FIX)xweight (kg)x1.3. This increased his activity to 100%. One IU of rFIX increased FIX activity by 0.8%; the half-life of rFIX is 18-24 hours. The rFIX infusion was started intraoperatively and continued after surgery to maintain target FIX activity. He was discharged on POD 9 on rFIX bolus dosing of 5000 IU every 12 hours for an additional 5 days. Using continuous factor infusion, we managed to decrease the amount rFIX used by >60% while maintaining steady state FIX activity level. Copyright (c) BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.
English
1757-790X
10.1136/bcr-2020-235859 [doi] 13/11/e235859 [pii] PMC7705362 [pmc]
*Coronary Artery Bypass
*Factor IX/ad [Administration & Dosage]
*Hemophilia B/dt [Drug Therapy]
Factor IX/me [Metabolism]
Hemophilia B/bl [Blood]
Hemophilia B/co [Complications]
Humans
Infusions, Intravenous
Male
Middle Aged
Recombinant Proteins/ad [Administration & Dosage]
MedStar Washington Hospital Center
Washington Cancer Institute
Medicine/Internal Medicine
Journal Article