Cholecystectomy in a man with hemophilia A and inhibitor on emicizumab prophylaxis: a case report

• Autor(a) principal: Paula Cella Giacometto
• Data de Publicação: 2021
• Outros Autores: Marcello Tortelli Bavaresco, Juliana Alvares Teodoro, Ricardo Mesquita Camelo
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Institucional da UFMG
• Texto Completo: https://doi.org/10.1016/j.htct.2022.10.003; http://hdl.handle.net/1843/56591; https://orcid.org/0000-0002-4023-275X; https://orcid.org/0000-0003-3685-1555; https://orcid.org/0000-0002-0210-0721; https://orcid.org/0000-0001-9025-0289
• topic: Hemophilia A; Inhibitor; Emicizumab; Surgery; Cholecystectomy; Hemofilia; Inibidores; Colecistectomia

Inherited hemophilia A is a rare bleeding disorder due to absent/reduced activity of the clotting factor VIII (FVIII).1 Therefore, its treatment is based on regular FVIII infusions to prevent (i.e., prophylaxis) or treat (i.e., on demand) bleedings.1 The most impacting complication of this treatment is the development of anti-FVIII antibodies (i.e., inhibitors).1 Inhibitors reduce/abolish the clotting activity of FVIII, rendering the patients with the previous or worse bleeding phenotype, which ultimately leads to increased morbimortality.1 Although bypassing agents (recombinant activated factor VII [rFVIIa] and partially activated prothrombin complex [aPCC]) can be prescribed for both prophylactic and on-demand treatments, the current recommended prophylactic drug in such cases is the humanized bispecific antibody emicizumab.1,2 Emicizumab mimics the clotting effect of FVIII and, since its structure is not similar to the FVIII structure, anti-FVIII inhibitors have no effect on its clotting activity.1,2 There are few reports about the hemostatic effectiveness and safety of this biopharmaceutical on major non-orthopedic surgeries.3, 4, 5 In addition, since the introduction of emicizumab in the armamentarium for hemophilia treatment in Brazil, in 2018, no major surgical procedures have been reported in Brazilian patients on emicizumab prophylaxis. Herein we described a man with severe hemophilia A and high-responding inhibitor under emicizumab prophylaxis who was submitted to open cholecystectomy due to acute-on-chronic calculous cholecystitis. This report was approved by the local Committee on Ethics on Research (May/29/2019). The patient signed the Consent Form before his data was reviewed on the hospital medical files.