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DOI: 10.1055/s-0045-1809707
Intracranial Hemorrhage in a Patient of Hemophilia A with Factor VIII Inhibitors Positive: A Case Report
Autor*innen
Abstract
Management of intracranial hemorrhage in a patient with hemophilia A and high-titer inhibitors presents a significant challenge to the neurointensivist. The decision between conservative and surgical approaches involves a delicate risk–benefit balance. While conservative management is costly and carries the risk of sudden deterioration, surgical intervention is often complicated by the high likelihood of rebleeding. We report the successful critical care management of a 50-year-old male with hemophilia A and high-titer factor VIII inhibitors who presented with an acute-on-chronic subdural hematoma. His factor VIII levels were markedly low, and conventional factor VIII replacement therapy was ineffective. The bleeding manifestations and laboratory parameters did not improve with standard treatment. The patient was successfully managed using sequential or combined bypassing agent therapy.
Publikationsverlauf
Artikel online veröffentlicht:
16. Juli 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Tiede A, Collins P, Knoebl P. et al. International recommendations on the diagnosis and treatment of acquired hemophilia A. Haematologica 2020; 105 (07) 1791-1801
- 2 Knoebl P, Marco P, Baudo F. et al; EACH2 Registry Contributors. Demographic and clinical data in acquired hemophilia A: results from the European Acquired Haemophilia Registry (EACH2). J Thromb Haemost 2012; 10 (04) 622-631
- 3 Zwagemaker AF, Gouw SC, Jansen JS, Vuong C. et al. Incidence and mortality rates of intracranial hemorrhage in hemophilia: a systematic review and meta-analysis. Blood, The Journal of the American Society of Hematology 2021; 138 (26) 2853-73
- 4 Brackmann HH, Wallny T. Immune tolerance: high-dose regimen. In: Rodriguez-Merchan EC, Lee CA. eds. Inhibitors in Patients Haemophilia. Oxford: Blackwell Science; 2002: 45-48
- 5 Verbruggen B. Diagnosis and quantification of factor VIII inhibitors. Haemophilia 2010; 16 (102) 20-24
- 6 Turecek PL, Váradi K, Gritsch H, Schwarz HP. FEIBA: mode of action. Haemophilia 2004; 10 (Suppl. 02) 3-9
- 7 Villar A, Aronis S, Morfini M. et al. Pharmacokinetics of activated recombinant coagulation factor VII (NovoSeven) in children vs. adults with haemophilia A. Haemophilia 2004; 10 (04) 352-359
- 8 Váradi K, Negrier C, Berntorp E. et al. Monitoring the bioavailability of FEIBA with a thrombin generation assay. J Thromb Haemost 2003; 1 (11) 2374-2380
- 9 Ho AY, Height SE, Smith MP. Immune tolerance therapy for haemophilia. Drugs 2000; 60 (03) 547-554
- 10 Seaman CD, Ragni MV. Sequential bypassing agents during major orthopedic surgery: a new approach to hemostasis. Blood Adv 2017; 1 (17) 1309-1311

