PO079 | PERIOPERATIVE MANAGEMENT OF MILD-TO-MODERATE HEMOPHILIA: A COMPARATIVE STUDY OF EXTENDED HALF-LIFE VERSUS STANDARD HALF-LIFE CONCENTRATES ON CLINICAL OUTCOMES AND FACTOR CONSUMPTION
Abstract
Background and Aims. In recent years, extended half-life concentrates (EHLs) have become an effective alternative to standard half-life concentrates (SHLs) in hemophilia, offering improved pharmacokinetics and reduced infusion frequency. These features make EHLs particularly attractive for perioperative management. While their efficacy and safety in surgery have been confirmed in severe or moderate-severe hemophilia, evidence remains scarce for mild-to-moderate hemophilia. The aim of this study was to confirm perioperative safety and hemostatic efficacy of EHLs and to evaluate the reduction of factor consumption and number of infusions of EHLs compared to SHLs in patients with mild-to-moderate hemophilia A (HA) or B (HB). Methods. We retrospectively analyzed 191 patients with mild-to-moderate HA or HB and collected data from 27 EHLs-managed surgeries performed at our center in 22 patients from 2018 to 2026. Fourteen major (52%) and 13 minor (48%) surgeries were performed. Twenty patients (91%) had mild hemophilia and 2 (9%) had moderate hemophilia. Two patients had undergone the same surgery once with SHLs and once with EHLs allowing an intra-patient comparison. We also compared our data with published literature for the same procedures (direct comparison of major surgeries was not possible due to the lack of comparable literature data). Preoperative pharmacokinetic (PK) studies were conducted before 16 procedures (59%) to guide dosing strategies. Mean trough level of 55% (24h) and 31% (72h) were maintained. In two cases of major surgery, the emergency nature of the procedure precluded pharmacokinetic analysis. Regarding patients with HA, 11 procedures were performed using turoctocog alfa pegol, 4 with rurioctocog alfa pegol, 1 with damoctocog alfa pegol. Among patients with HB, nonacog beta pegol was utilized in 6 cases, eftrenonacog alfa and albutrepenonacog alfa in 2 cases each. Results. In both comparisons we observed a reduction in the number of infusions (Table 1a) and total factor consumption (Table 1a, Table 1b). All 27 surgeries were managed with a single preoperative infusion. Postoperative infusions were administered once daily, whereas the literature reports twice-daily infusions when using SHLs. The sole exception in our cohort was a patient with mild HA undergoing cardiac surgery, who required more frequent infusions within the first 24 hours post-surgery before early transition to a single daily infusion. No patients developed inhibitors; a single bleeding event was due to poor hemostasis. Conclusions. EHLs appear safe and effective for surgery in mild-to-moderate hemophilia, offering clinical advantages over SHLs across all analyzed populations, particularly in HB. While not statistically significant due to the limited cohort, these findings demonstrate a clinical advantage, despite the absence of baseline factor levels for literature-based cases. For HA, further improvements are expected with the advent of newer molecules.
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BibTeX
@article{capetta2026po079,
title = {{PO079 | PERIOPERATIVE MANAGEMENT OF MILD-TO-MODERATE HEMOPHILIA: A COMPARATIVE STUDY OF EXTENDED HALF-LIFE VERSUS STANDARD HALF-LIFE CONCENTRATES ON CLINICAL OUTCOMES AND FACTOR CONSUMPTION}},
author = {Matilde Capetta},
journal = {Bleeding, Thrombosis and Vascular Biology},
year = {2026},
month = oct,
url = {https://www.btvb.org/btvb/article/view/895},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - PO079 | PERIOPERATIVE MANAGEMENT OF MILD-TO-MODERATE HEMOPHILIA: A COMPARATIVE STUDY OF EXTENDED HALF-LIFE VERSUS STANDARD HALF-LIFE CONCENTRATES ON CLINICAL OUTCOMES AND FACTOR CONSUMPTION
AU - Matilde Capetta
PY - 2026
DA - 2026/10/26
JO - Bleeding, Thrombosis and Vascular Biology
UR - https://www.btvb.org/btvb/article/view/895
AB - Background and Aims. In recent years, extended half-life concentrates (EHLs) have become an effective alternative to standard half-life concentrates (SHLs) in hemophilia, offering improved pharmacokinetics and reduced infusion frequency. These features make EHLs particularly attractive for perioperative management. While their efficacy and safety in surgery have been confirmed in severe or moderate-severe hemophilia, evidence remains scarce for mild-to-moderate hemophilia. The aim of this study was to confirm perioperative safety and hemostatic efficacy of EHLs and to evaluate the reduction of factor consumption and number of infusions of EHLs compared to SHLs in patients with mild-to-moderate hemophilia A (HA) or B (HB). Methods. We retrospectively analyzed 191 patients with mild-to-moderate HA or HB and collected data from 27 EHLs-managed surgeries performed at our center in 22 patients from 2018 to 2026. Fourteen major (52%) and 13 minor (48%) surgeries were performed. Twenty patients (91%) had mild hemophilia and 2 (9%) had moderate hemophilia. Two patients had undergone the same surgery once with SHLs and once with EHLs allowing an intra-patient comparison. We also compared our data with published literature for the same procedures (direct comparison of major surgeries was not possible due to the lack of comparable literature data). Preoperative pharmacokinetic (PK) studies were conducted before 16 procedures (59%) to guide dosing strategies. Mean trough level of 55% (24h) and 31% (72h) were maintained. In two cases of major surgery, the emergency nature of the procedure precluded pharmacokinetic analysis. Regarding patients with HA, 11 procedures were performed using turoctocog alfa pegol, 4 with rurioctocog alfa pegol, 1 with damoctocog alfa pegol. Among patients with HB, nonacog beta pegol was utilized in 6 cases, eftrenonacog alfa and albutrepenonacog alfa in 2 cases each. Results. In both comparisons we observed a reduction in the number of infusions (Table 1a) and total factor consumption (Table 1a, Table 1b). All 27 surgeries were managed with a single preoperative infusion. Postoperative infusions were administered once daily, whereas the literature reports twice-daily infusions when using SHLs. The sole exception in our cohort was a patient with mild HA undergoing cardiac surgery, who required more frequent infusions within the first 24 hours post-surgery before early transition to a single daily infusion. No patients developed inhibitors; a single bleeding event was due to poor hemostasis. Conclusions. EHLs appear safe and effective for surgery in mild-to-moderate hemophilia, offering clinical advantages over SHLs across all analyzed populations, particularly in HB. While not statistically significant due to the limited cohort, these findings demonstrate a clinical advantage, despite the absence of baseline factor levels for literature-based cases. For HA, further improvements are expected with the advent of newer molecules.
SN - 2785-5309
ER -