Efanesoctocog Alfa for the Management of a Life-Threatening Intracranial Haemorrhage in Mild Haemophilia A: A Case Report

Mild haemophilia A (HA; baseline factor VIII (FVIII) 5-40 IU/dL) is usually free of spontaneous bleeding, but high-energy trauma or major surgery can precipitate life-threatening haemorrhage requiring prolonged haemostatic coverage.These patients are typically treated on demand, are rarely trained in self-infusion, and lack an established treatment model.Efanesoctocog alfa, a first-in-class FVIII replacement therapy with a high sustained activity (HSA), has been studied almost exclusively in severe HA.We report a 33-year-old man with mild HA (baseline FVIII 22 IU/dL) who sustained a severe traumatic left temporal epidural haematoma with associated skull-base and pelvic fractures.After an initial standard FVIII bolus, he was managed with efanesoctocog alfa using a progressively spaced regimen, with FVIII monitored by chromogenic assay corrected per the manufacturer's recommendation.Complete radiological resolution occurred by week 8 without rebleeding; no inhibitor developed.The bleed was controlled with only seven infusions in the first 14 days and without central venous access, tapering to conventional weekly dosing.We discuss why the pharmacokinetic profile of efanesoctocog alfa is particularly advantageous in the mild phenotype and how the same properties extend to major surgery, together with a cautious appraisal of its cost profile, which is strongly dependent on the healthcare system.