Pharmacokinetic parameters and clinical experience with perioperative continuous infusion of coagulation factor VIII and IX concentrates in children with hemophilia A and B

Introduction . Сontinuous infusion of factor concentrate makes it possible to achieve stable activity of the deficient factor over a long period of time and appears to be an attractive alternative to bolus administration of concentrate as part of perioperative prophylaxis. The aim of the study – evaluation of pharmacokinetic parameters when using continuous factor infusion VIII and IX concentrates in children with hemophilia A and B in the perioperative period in real clinical practice. Materials and methods . A retrospective analysis of medical records data from children with hemophilia A and B who underwent surgical treatment with continuous infusion of factor VIII concentrate was performed at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology from 2015 to 2024. The following pharmacokinetic parameters were also assessed during administration (ACL TOP 700): activity of factors VIII and IX before the administration of concentrate, 30 min after the administration of the concentrate dose and the start of surgery, at finish of the surgery and also every 24 h from the time of surgery until the factor infusion was stopped (single-stage clotting method for determining HemosIL, Instrumentation Laboratory, USA), activated partial thromboplastin time and thromboelastogram. An assessment of bleeding, the presence of an inhibitor to the factor and thrombosis in the early postoperative period was carried out. Results . The study included 5 patients with hemophilia A and 2 patients with hemophilia B. Before surgery, all patients received bolus infusion at a dose of 1000 to 5000 IU with subsequent transition to continuous factor infusion at a median dose of 5 IU/kg/h (range – 3.5 to 9,0 IU/kg/h). All patients had stable pharmacokinetic parameters; the activity of the deficient factor was in the expected range. No patient had complications of surgery with bleeding or thrombosis. Conclusions . In real clinical practice, when using continuous infusion of factor VIII concentrate at a dose of 3,5–9,0 IU/kg/h, stable pharmacokinetic parameters are achieved, allowing its use in children when planning perioperative management.