Hemostatic treatment options for AHA
| . | Pros . | Cons . |
|---|---|---|
| rpFVIII | More specific than bypassing agents More effective than human FVIII | Requires ongoing FVIII monitoring Some inhibitors may have cross-reactivity |
| rFVIII | More specific than bypassing agents | Likely requires very large doses and will not be able to achieve goal levels with high titer inhibitors Requires ongoing FVIII monitoring |
| aPCC | 2-3 times daily Laboratory monitoring not required | Nonspecific and potentially ineffective in some patients No laboratory measure of efficacy |
| rFVIIa | May be effective in patients who do not respond to aPCC or rFVIII, or when rpFVIII is not available Laboratory monitoring not required | Nonspecific and potentially ineffective in some patients. Very frequent dosing (daily, every 2-3 hours) required No laboratory measure of efficacy |
| Tranexamic acid | Has some efficacy, especially for mucosal bleeding Oral and IV routes. Efficacy not reduced by inhibitor presence | Likely to be inadequate as a single-agent therapy Should not be administered with aPCC because of DIC risk |
| Emicizumab | May reduce/eliminate risk of bleeding with infrequent subcutaneous dosing | Not effective or adequate for acute bleeding Studies ongoing, thus, data limited Interferes with inhibitor monitoring May not ameliorate need for additional/more specific therapies Is contraindicated in conjunction with aPCC |
| . | Pros . | Cons . |
|---|---|---|
| rpFVIII | More specific than bypassing agents More effective than human FVIII | Requires ongoing FVIII monitoring Some inhibitors may have cross-reactivity |
| rFVIII | More specific than bypassing agents | Likely requires very large doses and will not be able to achieve goal levels with high titer inhibitors Requires ongoing FVIII monitoring |
| aPCC | 2-3 times daily Laboratory monitoring not required | Nonspecific and potentially ineffective in some patients No laboratory measure of efficacy |
| rFVIIa | May be effective in patients who do not respond to aPCC or rFVIII, or when rpFVIII is not available Laboratory monitoring not required | Nonspecific and potentially ineffective in some patients. Very frequent dosing (daily, every 2-3 hours) required No laboratory measure of efficacy |
| Tranexamic acid | Has some efficacy, especially for mucosal bleeding Oral and IV routes. Efficacy not reduced by inhibitor presence | Likely to be inadequate as a single-agent therapy Should not be administered with aPCC because of DIC risk |
| Emicizumab | May reduce/eliminate risk of bleeding with infrequent subcutaneous dosing | Not effective or adequate for acute bleeding Studies ongoing, thus, data limited Interferes with inhibitor monitoring May not ameliorate need for additional/more specific therapies Is contraindicated in conjunction with aPCC |