Considerations when choosing hemostatic agents to treat breakthrough bleeding on emicizumab
| . | Recombinant factor VII activated (rFVIIa) . | Activated prothrombin complex concentrate (aPCC) . | Recombinant porcine factor VIII (rpFVIII) . |
|---|---|---|---|
| Safety | • May increase risk of thrombosis (limited data in AHA); for congenital hemophilia A, the combination of emicizumab and rFVIIa was safe | • Thromboembolic events and thrombotic microangiopathies were reported with dose of >100 U/kg/24 hours and administered for >24 hours and the use of aPCC in people on emicizumab prophylaxis is relatively contraindicated | • Coadministration of rpFVIII and emicizumab has been reported in case series and theoretically does not have an additive effect as both compete for the same binding site |
| Limitation of use | • rFVIIa should only be reserved for acute severe breakthrough bleeding | • Avoid with emicizumab | • The chromogenic FVIII assay underestimated rpFVIII (Obizur) activity26 |
| . | Recombinant factor VII activated (rFVIIa) . | Activated prothrombin complex concentrate (aPCC) . | Recombinant porcine factor VIII (rpFVIII) . |
|---|---|---|---|
| Safety | • May increase risk of thrombosis (limited data in AHA); for congenital hemophilia A, the combination of emicizumab and rFVIIa was safe | • Thromboembolic events and thrombotic microangiopathies were reported with dose of >100 U/kg/24 hours and administered for >24 hours and the use of aPCC in people on emicizumab prophylaxis is relatively contraindicated | • Coadministration of rpFVIII and emicizumab has been reported in case series and theoretically does not have an additive effect as both compete for the same binding site |
| Limitation of use | • rFVIIa should only be reserved for acute severe breakthrough bleeding | • Avoid with emicizumab | • The chromogenic FVIII assay underestimated rpFVIII (Obizur) activity26 |