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Evidence summaries

Prophylactic Clotting Factor Concentrates to Prevent Bleeding Complications in Hemophilia A or B

Prophylactic clotting factor concentrates decrease bleeding and bleeding-related complications in children and probably also adults with severe hemophilia A or B compared to on-demand treatment. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 6 studies with a total of 142 subjects.

Two studies compared three-times-a-week prophylactic administration with on-demand treatment in children with hemophilia. Pooled results from these two studies showed a rate ratio of 0.30 (95% Cl 0.12 to 0.76) for all bleedings and 0.22 (95% Cl 0.08 to 0.63) for joint bleedings favouring prophylaxis. Three of the remaining four studies evaluated hemophilia A; one showed a statistically significant decrease in frequency of joint bleeds with prophylaxis compared to placebo, with a rate difference of -10.73 (95% Cl-16.55 to -4.91) bleeds per year. Two studies compared two prophylaxis regimens, failing to demonstrate an advantage of one regimen over the other in terms of bleeding frequency. The fourth study evaluated hemophilia B and showed fewer joint bleeds with weekly (15 IU/kg) versus bi-weekly (7.5 IU/kg) prophylaxis, rate difference -3.30 (95% Cl -5.50 to -1.10) bleeds per year.

    References

    • Iorio A, Marchesini E, Marcucci M et al. Clotting factor concentrates given to prevent bleeding and bleeding-related complications in people with hemophilia A or B. Cochrane Database Syst Rev 2011;(9):CD003429. [PubMed].

Primary/Secondary Keywords