Continuous infusion during total joint arthroplasty in Japanese haemophilia A patients: comparison study among two recombinants and one plasma-derived factor VIII.

As for the available factor VIII (FVIII) concentrates in Japan, there are two recombinant FVIII concentrates (Kogenate-FS and Advate) and one highly purified plasma-derived FVIII concentrate (Cross-Eight M). To evaluate the inter-product variability, the differences in the continuous infusion rates and total consumption of the above three concentrates were compared when continuous infusion was used as the administration mode to control bleeding during 28 total joint arthroplasties (TJAs) for 17 patients. There were no significant differences among the FVIII plasma levels during surgery, except day 0. Advate needed to be given at a significantly higher infusion rate (4.2-2.1 IU kg(-1) h(-1)) than the other two concentrates (Kogenate-FS: 1.0-2.9 IU kg(-1) h(-1), P < 0.01 and P < 0.05; Cross-Eight M: 3.2-1.8 IU kg(-1 )h(-1), P < 0.01); however, their infusion rates were within the rates which were previously reported. The total consumption of Advate (652.1 IU kg(-1)) was also significantly greater than either of the other concentrates (Kogenate-FS: 395.1 IU kg(-1), P < 0.01; Cross-Eight M: 519.1 IU kg(-1), P < 0.05). The results of this study showed that the continuous infusion of three FVIII concentrates is effective and safe during TJA, and also showed the differences in the continuous infusion rates and total consumption among concentrates when continuous infusion was used to control bleeding during surgery. These two results suggested that the continuous infusion of FVIII concentrate is a good administration mode, but there is still room for further investigation to use it as a more cost-effective and safer administration mode.