Electronic medical record alert in patients with hemophilia at a teaching hospital emergency department

P157 Introduction: Patients with hemophilia are often not treated appropriately when they present out-of-hours to an emergency department (ED). Delays in replacement therapy can affect morbi- mortality. Clinical decision support systems include electronic medical record alerts (EMRA) and guidelines that assist in diagnosis and treatment. Aim: Audit the computerized automated alert tool in the electronic medical record in order to notify the need of health care provision of hemophilia patients in ED. Methods: Retrospective review (February 2015- March 2019) of health care alert notification emails regarding of hemophilia patients in our centre, received and generated by computer alert in the electronic medical record of the ED. Results: 164 visits to ED were registered, corresponding to 39 (37.5%) of the 104 hemophilia patients (pts) from our center. 28 of 80 pts with hemophilia A (HA) and 11 of 24 pts with HB. Median age 25 years (range: 5- 67). 31 were adults (median 33 years; range: 15-67) and 8 children under 15 (range 5- 14). Distribution by type and severity: HA: severe 9, moderate 2, mild 17; HB: severe 8, moderate 1, mild 2. 16 were under prophylaxis and 23 on demand. 11 went once to ED, 9 twice, 5 pts 3 times and 14 (36.6%) >5 times (5 with associated comorbidities). Causes for consultation (59 due to trauma and 57 directly related to hemophilia): Cutaneous/muscle bleed 18 episodes (Iliopsoas 5, cutaneous 5, other muscle 8), Joint pain 38 (bleed 8, synovitis 5, sprain 6, contusion 9, knee pain 2, post- traumatic fracture 3, nonspecific pain 5), abdominal pain 14 (gastroenteritis 5, gastrointestinal bleed 4, inguinal hernia 1, nonspecific pain 4), traumatic incise wound 4, infection 14, treatment administration 15, gingivorrhagia 7, colic pain/hematuria 7, toothache 4, allergic skin reaction 4, epistaxis 3, head trauma 2 and other causes not related to hemophilia 34 episodes. 23 hospital admissions were made in16 pts. The average length of stay of all patients admitted to ED was 4.8 hours as opposed to 2.4 hours (range: 0.1- 44.3) in hemophiliacs. Discussion/Conclusion: In our experience, only one third of patients consult with symptoms related to hemophilia at ED. The reason for hospital admission is mostly associated to other comorbidities. EMRA system allows early care provision, better compliance with the healthcare protocol, and shorten the length of stay and reducing morbidity in hemophilia patients

Intraoperative radiotherapy electron boost followed by moderate doses of external beam radiotherapy in resected soft-tissue sarcoma of the extremities

To analyze the patterns of failure and the toxicity profile of intraoperative electron beam radiotherapy (IOERT) after resection of soft tissue sarcomas of the extremities (STS). PATIENTS AND METHODS: Forty-five patients with extremity STS were treated with IOERT and moderate-dose postoperative radiotherapy (45-50 Gy). Twenty-six patients were treated for primary disease (PD) and 19 patients for an isolated recurrence (ILR). Tumor size was >5 cm (maximum diameter) in 36 patients (80%), and high-grade histology in PD patients was present in 14 patients (54%). In nine patients, IOERT was used alone, due to previous irradiation or patient refusal. Chemotherapy (neoadjuvant and/or adjuvant) was mainly given to high-grade tumors. RESULTS: Nine patients relapsed in the extremity (20%), and 12 patients in distant sites (28%). Actuarial local control at 5 years was 88% for patients with negative/close margins and 57% for patients presenting positive margins (P=0.04). Five patients (11%) developed neuropathy associated with the treatment. Extremity preservation was achieved in 40 patients (88%). With a median follow-up of 93 months (range: 27-143 months) for the patients at risk, 25 patients remain alive (a 7-year actuarial survival rate of 75% for PD and 47% for ILR; P=0.01). CONCLUSIONS: IOERT combined with moderate doses of external beam irradiation yields high local control and extremity preservation rates in resected extremity STS. Peripheral nerves in the IOERT field are dose-limiting structures requiring a dose compromise in the IOERT component to avoid severe neurological damage

Análisis del switch guiado por farmacocinética de factores VIII de semivida estándar a factores de semivida extendida

CO-170 Introducción y objetivos: Los factores VIII (FVIII) de semivida extendida (EHL) han mostrado en los ensayos clínicos mejoras de al menos 1, 3 veces la semivida plasmática (t1/2) y 1, 25 veces el área bajo la curva (AUC) respecto a los FVIII estándar (SHL). Herramientas basadas en modelos farmacocinéticos (PK) poblacionales permiten estimar los parámetros PK individuales y ajustar la profilaxis. El objetivo de este estudio es analizar el switch PK-guiado de SHL a EHL en pacientes con hemofilia A (HA). Métodos: Estudio multicéntrico comparativo, cruzado, prospectivo que analiza las diferencias PK tras el cambio de factores SHL a EHL (Elocta® y Adynovi®) en pacientes con HA grave/moderada en profilaxis. Se ha empleado el PopPK WAPPS-Hemo® con 2-3 muestras para realizar un perfil PK individualizado de los valores de FVIII. Los parámetros PK analizados son: t1/2, AUC, nivel pico (NP), nivel valle a las 24, 48 y/o 72 h (NV24/NV48/NV72) y tiempo para alcanzar niveles de FVIII del 5%, 2% y 1% (T5%/T2%/T1%). También analizamos los ratios de t1/2 y AUC, el nº dosis semanales y la dosis/kg/semana. Para comparar los parámetros PK entre ambos periodos empleamos los test de Wilcoxon y Kruskal-Wallis (SPSS®). Los resultados se expresaron con la mediana y el rango o rango intercuartílico (RIC). Resultados: Se han analizado 64 pacientes procedentes de 8 hospitales españoles (48 switch a Elocta® y 16 a Adynovi®), 62 con HA grave y 2 con HA moderada, con una mediana de edad de 32 años (rango=5-64) y sin diferencias en el peso entre ambos periodo [71, 0 (rango=12-116) vs 72, 0 (16, 9- 116) kg; p=0, 156]. La dosis/kg/semana se redujo tras el switch a EHL [74, 5 (RIC:59, 2-108, 1) vs 69, 2 (RIC:46, 2-96, 7) UI/kg/semana; p<0, 0001], así como ..