Svarc Petra, Kampmann Peter, Lönn Lars, Røder Martin Andreas
Department of Radiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark.
CVIR Endovasc. 2022 Apr 21;5(1):21. doi: 10.1186/s42155-022-00299-x.
This is the first case report describing the peri- and postoperative hemostasis plans in two men with severe hemophilia A (HA) who underwent prostatic artery embolization (PAE) for symptomatic benign prostatic hyperplasia (BPH).
Two patients with severe HA and lower urinary tract symptoms (LUTS) not responding to medical therapy underwent PAE at our institution. In both patients, intermittent administration of decreasing doses of extended half-life recombinant factor VIII (EHL rFVIII) concentrate from 30 min before to 7 days after the PAE resulted in good hemostatic control. In addition to EHL rFVIII, tranexamic acid was administered in the same timeframe to augment the action of EHL rFVIII and to account for possible mucosal bleeding from the urinary tract. Both patients reported a minor localized hematoma at the femoral puncture site in the right groin, that resolved spontaneously. No other bleeding complications were observed.
The procoagulant effects of the chosen dosing of EHL rFVIII showed sufficient to perform a technically successful embolization. At 6 months follow-up, both patients had significant reduction in self-reported urinary symptoms and were content with the outcome.
本文是首例关于两名重度甲型血友病（HA）男性患者的围手术期和术后止血方案的病例报告，这两名患者因症状性良性前列腺增生（BPH）接受了前列腺动脉栓塞术（PAE）。
两名患有重度HA且下尿路症状（LUTS）对药物治疗无反应的患者在我院接受了PAE。在这两名患者中，从PAE前30分钟至术后7天间歇性给予递减剂量的延长半衰期重组凝血因子VIII（EHL rFVIII）浓缩物，实现了良好的止血控制。除了EHL rFVIII，在同一时间段内还给予了氨甲环酸，以增强EHL rFVIII的作用，并应对可能来自尿路的黏膜出血。两名患者均报告右腹股沟股动脉穿刺部位出现轻微局部血肿，该血肿自行消退。未观察到其他出血并发症。
所选剂量的EHL rFVIII的促凝血作用足以使栓塞术在技术上取得成功。在6个月的随访中，两名患者自我报告的泌尿症状均显著减轻，对结果满意。
