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The treatment of hemophilia consists of clotting factor replacement to prevent and control bleeding. The development of an inhibitor is one of the most serious complications of the disease, rendering patients refractory to factor replacement therapy. Hemostasis may be achieved in patients with high antibody titers by administering bypassing agents (BPA). 1, 2 The two major BPA are activated prothrombin complex concentrate (APCC) and recombinant activated factor VII (rFVIIa). These agents have complex and multiple modes of action, but in all cases, the final product generated by BPA is thrombin. Our group and others have therefore suggested that the thrombin generation assay (TGA) may be a reasonable tool to assess the hemostatic properties of these agents. 3-6

Emicizumab offers the potential of a novel treatment approach for hemophilia A, with or without inhibitors. 7 In case of breakthrough bleeding while …