Clinical study on perioperative replacement therapy guided by pharmacokinetics in patients with hemophilia A
Objective To investigate the perioperative management of hemophilia A patients under the guidance of pharmacokinetics(PK).Methods PK and clinical data of 29 hemophilia A patients admitted to the First Affiliated Hospital of Guangxi Medical University from January 2013 to February 2023 were retrospectively analyzed.The patients were divided into weight-guided treatment group(n=19)and PK-guided treatment group(n=10)according to treatment mode.The main analysis parameter was the target coagulation factor compliance rate.The safety analysis included perioperative complications,incidence of bleeding or thrombosis,requirement of second operation and blood transfusion,and the perioperative coagulation factor Ⅷ(factor Ⅷ,FⅧ)consumption.Results The perioperative target coagulation factor sccucess rate was 88%in the PK-guided treatment group and 33%in the weight-guided treatment group,and the difference in median target coagulation factor sccucess rate between the two groups was statistically significant(P<0.01).The incidence of bleeding events in the PK-guided treatment group was 90%,and all were grade 1 bleeding events;the incidence of bleeding events in the weight-guided treatment group was 100%,with the incidence of grade 1 bleeding events being 78.9%,the incidence of grade 2 bleeding events being 10.5%and the incidence of grade 3 and grade 4 bleeding events were both 6.7%.The difference in the incidence of bleeding events between the two groups was statistically significant(P<0.05).The incidence of bleeding events was significantly different between the two groups(P<0.05).There was no blood transfusion in PK group,and the incidence of blood transfusion was 21.1%in weight group.There were no cases of thrombosis or secondary operation in both groups,and no treatment-related death occurred.The median consumption of perioperative coagulation factor was 116.5 IU/kg in the PK-guided treatment group and 120 IU/kg in the weight-guided treatment group.There was no statistically significant difference between the two groups(P>0.05).Conclusion Compared with the weight-guided treatment group,the PK-guided treatment group for perioperative hemophilia A patients had a better effect on the target coagulation factor compliance rate,and reduced the bleeding events and blood transfusion treatment,which is worthy of clinical promotion.
万方数据
维普
