Continuous and intermittent infusion of coagulation factor concentrates in patients undergoing surgery: a single centre Australian experience

Background: Haemophilia patients require large doses of coagulation factor concentrates to optimise haemostasis at the time of surgery. The superior pharmacokinetic profile of continuous infusion over intermittent bolus administration may be more advantageous. Aims: We report our experience using coagulation factor concentrates delivered by continuous infusion in patients undergoing surgery. Methods: A retrospective case notes review of all patients treated by continuous infusion at Royal Prince Alfred Hospital (RPAH) over a two year period and a comparison of two cohorts of patients undergoing orthopaedic surgery using either continuous infusion or bolus factor VIII (FVIII) replacement therapy. Patients received a pre-operative bolus of factor concentrate (AHF, Immunine or Recombinate) followed by a continuous infusion calculated according to weight, clearance and target plasma concentration. Results: Twenty-one (19 M, two F) with haemophilia or von Willebrand's disease underwent 26 surgical procedures between July 1995 and July 1997. The mean total consumption of concentrate per patient was 36,676 units (range 6750-82,000) infused over a mean period of 7.6 days (range one-16). One patient experienced minor surgical bleeding on treatment and one patient developed severe bleeding into the replaced joint off infusion requiring additional boluses of treatment. In a separate analysis, ten of these patients who underwent major orthopaedic surgery were compared to a historic cohort (n=8) of patients who received bolus injections for similar types of operations. Conclusions: Coagulation factor concentrates delivered by continuous infusion have major clinical and economic advantages in the surgical management of patients with haemophilia.