Surgical management with emicizumab: Emicizumab will improve but not normalize hemostasis during surgery, so emicizumab alone should not be presumed as adequate for major procedures.
Bypass therapy recommendations for patients with inhibitors.
Patients with congenital hemophilia A or B with inhibitors (CHAwI or CHBwI) are twice as likely to be hospitalized for a bleeding complication.1 NovoSeven® RT is listed among recommended bypassing agents to stop bleeds.2
A first-line treatment option for CHAwI.
Patients receiving emicizumab prophylaxis can still experience breakthrough bleeds and will need concomitant use of alternate hemostatic therapies.3,a
MASAC recommends rFVIIa as a first option to treat acute bleeding episodes in patients on emicizumab—aPCC should be avoided if possible.3
aPlease refer to the full MASAC recommendations document #255 from December 6, 2018 for full guidance around treatment of bleeding episodes and surgery.