Management of patients with inherited bleeding disorders in oral surgery: A 13-year experience

International audienc

Variants du facteur VII de la coagulation : quelle thromboplastine utiliser pour doser son activité ?

International audienceLe déficit constitutionnel en facteur VII de la coagulation (FVII), caractérisé par une grande hétérogénéité clinique et biologique, a pour particularité de présenter des variants FVII dont le dosage de l’activité (FVII:C) varie selon la thromboplastine utilisée. Il s’agit en particulier des variants p.Arg364Gln et p.Arg139Gln, très fréquents sur le continent africain et dans le sud de l’Europe, mais la liste de ces variants s’allonge avec la caractérisation moléculaire des déficits en FVII. Les hypothèses physiopathologiques reposent sur la différence de la séquence protéique des facteurs tissulaires humains ou de lapin composant les thromboplastines. L’analyse des phénotypes cliniques associés conforte l’option consistant à retenir la valeur obtenue avec une thromboplastine humaine, c’est-à-dire composée du facteur tissulaire physiologique. Il est ainsi recommandé de contrôler toute valeur de FVII:C dans le cadre d’un déficit constitutionnel en FVII afin de ne pas surtraiter ces patients

Abnormal bleeding phenotype for mild haemophilia B patients with the p.Ile112Thr variation on the gene for factor IX

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Congenital factor XIII deficiency: comprehensive overview of the FranceCoag cohort

International audienceThis FranceCoag network study assessed 33 patients with congenital factor XIII (FXIII) deficiency presenting FXIII levels <10 iu/dl. Diagnosis was based on abnormal bleeding in 29 patients, a positive family history in 2, recurrent miscarriages in 1 and was fortuitous in 1. Eighteen patients (62·1%) presented life‐threatening umbilical or intracranial haemorrhages (ICH). Seven of the 15 patients who experienced ICH were diagnosed but untreated, including 3 with secondary neurological sequelae. All pregnancies without prophylaxis (26/26) led to miscarriages versus 3/16 with prophylaxis. In patients exhibiting FXIII levels <10 iu/dl, prophylaxis could be discussed at diagnosis and at pregnancy. Further controlled prospective studies are needed

Management of von Willebrand disease with a factor VIII‐poor von Willebrand factor concentrate: Results from a prospective observational post‐marketing study

International audienceBackground A triple-secured plasma-derived von Willebrand factor (pdVWF) almost devoid of factor VIII (FVIII):WILFACTIN(R), was approved in France in 2003, and then in other countries for the treatment of patients with von Willebrand disease (VWD). Objective To investigate long-term safety and efficacy of the product in real-life over the first 5 post-approval years. Patients/Methods This prospective, observational, national post-marketing study (PMS) enrolled patients of all ages and VWD types. Patients were observed for up to 3 years and treated for one or more occasions. Efficacy was assessed for each major event. Breakthrough bleeding rate 3 days post-infusion and annualized bleeding rate (ABR) were also evaluated for long-term prophylaxis. Results Overall, 155 of 174 patients enrolled from 31 centers were eligible for efficacy assessment. Most patients (76.8%) were severely affected (VWF:RCo = 12 months. Excellent tolerability was confirmed with no safety concerns. No thrombotic events were observed. Conclusions Results from this PMS increase the clinical experience of a FVIII-poor pdVWF in patients of all ages and VWD types including those with thrombotic risk factors and emphasize that giving FVIII is not always mandatory to effectively treat patients with severe VWD

Real Life Population Pharmacokinetics Modelling of Eight Factors VIII in Patients with Severe Haemophilia A: Is It Always Relevant to Switch to an Extended Half-Life?

International audienc

Surgery in rare bleeding disorders: the prospective MARACHI study

International audienc

Determinants of adherence and consequences of the transition from adolescence to adulthood among young people with severe haemophilia (TRANSHEMO): A multicentric French national observational cross‐sectional study based on the FranceCoag registry

International audienceAbstract Introduction It is necessary to gain insights into adherence to healthcare in people with severe haemophilia (PwSH), especially during the transition from paediatric to adult care, which is an important phase in lives of young people with childhood chronic disease. This adherence can be considered as a marker of successful transition. Objectives The main objective of the quantitative phase of the TRANSHEMO project was to compare the adherence to healthcare between adolescents and young adults (YAs) with severe haemophilia. The secondary objective was to identify the determinants (facilitators and barriers) of this adherence and associations between these determinants. Methods A multicentre, observational, cross‐sectional study was conducted in 2017–2019 on PwSH aged between 14 and 17 years (adolescents) or between 20 and 29 years (YAs), included in the FranceCoag registry and having completed the questionnaires. The adherence to healthcare (treatment regimens and clinical follow‐up) was compared between adolescents and YAs using the chi‐squared test. The determinants of this adherence were analysed by structural equation modelling. Results There were 277 participants, 107 adolescents, and 170 YAs. The rate of adolescents adhering to healthcare was 82.2%, while the rate of YAs was 61.2% ( p < .001). The barriers to the adherence to healthcare were being YA, having repeated at least one school grade and presenting mental health concerns. Conclusion Adolescents had better adherence to healthcare than YAs. According to the determinants enlightened in this project, targeted supportive strategies and adapted therapeutic education programs can be developed for young PwSH to facilitate their adherence to healthcare

Obstetrical complications in hereditary fibrinogen disorders: the Fibrinogest Study.

BACKGROUND Women with hereditary fibrinogen disorders (HFDs) seem to be at increased risk of adverse obstetrical outcomes, but epidemiologic data are limited Patients/methods: We conducted a retrospective and prospective international study to determine the prevalence of pregnancy complications, the modalities and management of delivery, and the postpartum events. RESULTS A total of 425 pregnancies were investigated from 159 women (49 hypofibrinogenemia, 95 dysfibrinogenemia, 15 hypodysfibrinogenemia). Overall, only 55 (12.9%) pregnancies resulted in an early miscarriage, 3 (0.7%) in a late miscarriage and 4 (0.9%) in an intrauterine fetal death. Prevalence of live birth was similar among the types of HFD (p=0.31). Obstetrical complications were observed in 54 (17.3%) of live birth pregnancies, including vaginal bleeding (14, 4.4%), retroplacental hematoma (13, 4.1%), and thrombosis (4, 1.3%). Most 56deliveries were spontaneous (218, 74.1%) with a vaginal non-instrumental delivery (195, 63.3%). A neuraxial anesthesia was performed in 116 (40.4%) pregnancies, while 71 (16.6%) and 129 (44.9%) were under general or no anesthesia, respectively. A fibrinogen infusion was administered in 28 (8.9%) deliveries. Postpartum hemorrhages were observed in 62 (19.9%) of pregnancies. Postpartum venous thrombotic events occurred in 5 (1.6%) pregnancies. Women with hypofibrinogenemia were more at risk of bleeding during the pregnancy (p=0.04). CONCLUSIONS Compared to European epidemiologic data, we did not observe a greater frequency of miscarriage while retroplacental hematoma, postpartum hemorrhage and thrombosis were more frequent. Delivery was often performed without locoregional anesthesia. Our findings highlight the urgent need for guidance on management of pregnancy in HFDs