Delphi consensus on managing prophylactic treatment in patients with severe hemophilia A in Spain
- 2023, Volume 42 - Number 1
- Published: July 14, 2023
Delphi consensus on managing prophylactic treatment in patients with severe hemophilia A in Spain
M.ª Teresa Álvarez-Román 1, Rubén Berrueco 2, Saturnino Haya 3, Ana Moretó 4, Manuel Rodríguez-López 5, María Mareque 6, Miguel Á. Casado 6
1 Servicio de Hematología y Hemoterapia, Hospital Universitario La Paz, Madrid, España; 2 Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; 3 Unidad de Hemostasia y Trombosis, Servicio de Hematología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; 4 Hospital Universitario Cruces, Bilbao, Spain; 5 Servicio de Hematología y Hemoterapia, Hospital Universitario Álvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia-Sur (IISGS), EOXI, Vigo, España; 6 Pharmacoeconomics and Outcomes Research Iberia (PORIB), Madrid, Spain
M.ª Teresa Álvarez-Román, Rubén Berrueco, Saturnino Haya, Ana Moretó, Manuel Rodríguez-López, María Mareque, Miguel Á. Casado
La información completa de afiliaciones y autor de correspondencia está disponible en la versión original en PDF.
*Correspondence: Ana Moretó, Email not available
Summary
Objective: To evaluate, using the Delphi method, the management of prophylactic treatment, bleeding control and surgery with standard-life (SHL) factor VIII (FVIII), extended-half-life (EHL). FVIII and emicizumab in patients with severe hemophilia A (HA) in Spain. Methods: A 1st questionnaire was validated by a Scientific Committee and sent to 85 hematologists. “Consensus” or “intermediate consensus” was determined when ≥ 80% or ≥ 70% of the experts selected the same answer. A 1st questionnaire was sent to the experts of the 1st round, and a discussion process with the scientific committee was started. Results: In both the 1st and 2nd rounds 27 and 24 experts participated, respectively. “Consensus” was reached on 107 items, “intermediate consensus” on 15, and “no consensus” on 14. In prophylactic treatment, 93% of the experts use recombinant FVIII. A guideline of 20-50 and 20-40 IU/kg 3 times/week was agreed for pediatric and adults treated with SHL recombinant FVIII, respectively and 25-65 IU/kg every 3-5 days for patients on EHL FVIII. Moderate/severe bleeding is treated similarly and intensively with administrations every 12 h. There is consensus on management regimens regarding major surgery. In emicizumab prophylaxis, consensus was not reached regarding monitoring. Conclusions: There is a great consensus in the management of patients with HA in Spain.
Keywords: Delphi method. Hemophilia A. Spain. Prophylactic treatment. Bleeding control. Surgery.
