Use of extended half-life factor IX products in the surgical setting: case series from a UK haemophilia centre

Abstract Introduction For people with haemophilia, surgical procedures, whether haemophilia-related or for other conditions, are associated with a risk of bleeding. Factor activity levels must be maintained for any invasive intervention. Clinical studies have shown that extended half-life (EHL) recombinant factor products are beneficial in this context. Clinical nurse specialists working in comprehensive care centres play a central role in preparing patients for surgery and in coordinating the surgical process. This case series reports on the nurse experience of using EHL-FIX products in surgery in a small UK cohort of people with haemophilia B (PwHB). Methods A consecutive series of PwHB who underwent minor and major surgery from 2018–2022 were identified from the Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free London NHS Foundation Trust database. Variables retrieved included age, haemophilia severity, surgery details (type, day/inpatient, major/minor, inpatient stay length, day surgery location, EHL FIX product used and consumption. Comparative data for patients receiving standard half-life FIX during the same surgery were also sought. Results Twenty-two surgeries were performed during the period covered (9 major, 13 minor), 12 of which were orthopaedic. All surgeries were completed without the need for continuous infusion. For 6 of 13 minor surgeries, and 1 of 9 major surgeries, only a single infusion of EHL FIX product was required. The use of EHL FIX allowed some minor procedures to be performed at local facilities rather than within the main hospital setting. Most major surgeries required an inpatient stay of 1–4 days and fewer than three infusions of an EHL FIX product. Total EHL FIX consumption ranged from 5,000 to 46,000 IU for major surgery, and from 3,000 to 13,000 IU for minor procedures. Conclusion EHL FIX allows for intermittent infusions, thus avoiding the requirement for continuous infusions and making outpatient treatment possible for some minor surgeries. Reduced dosing frequency and FIX consumption, greater protection from postoperative bleeding complications enabling a better recovery and a shorter hospital stay all reduce demands on medical personnel and could significantly reduce costs associated with surgery in PwHB.