Table 4.

Summary of surgical procedures performed during trial

Surgery no.Hemophilia subtype and inhibitor statusFitusiran dosing regimenAT activity level on day of or before surgery and timingType of procedurePerioperative hemostatic agent(s) usedHemostasis efficacy rating AEs in perioperative period
HA Discontinued before surgery, due to dosing hold 54.2% (at time of procedure) Laparoscopic cholecystectomy FVIII Excellent CRP increased, LDH increased 
HB with inhibitors Original dose regimen ongoing 12.3% (on day of surgery) Right ankle fusion and Achilles tendon lengthening rFVIIa Excellent None 
HA with inhibitors Paused due to surgery 17.7% (62 days before surgery) Left knee total replacement aPCC Not reported  Anemia postoperative, blood loss anemia, and post procedural edema 
HA with inhibitors Original dose regimen ongoing 13.0% (1 day before surgery) Metal plate removal and right hip total replacement aPCC Not reported  Mild postoperative hematoma reported 1 day after surgery, which required no treatment; postoperative anemia 
HA with inhibitors Original dose regimen ongoing 12.6% (1 day before surgery) Left knee total replacement aPCC Not reported  None 
HA Original dose regimen ongoing 15.0% (1 day before surgery) Nasal septoplasty FVIII Excellent None 
HA Original dose regimen ongoing 13.3% (21 days before surgery) Endoscopic Cholecystectomy FVIII Excellent None 
HA Original dose and regimen ongoing 15.7% (18 day before surgery) Extraction of two wisdom teeth None Not rated  None 
HA Original dose regimen ongoing 13.2% (3 days before surgery) Bilateral knee replacement FVIII Excellent None 
10 HB AT-based dose regimen ongoing 12.2% (2 day before surgery) Tooth extraction AT III (human) (before surgery)
Tranexamic acid (day of procedure) 
Excellent None 
Surgery no.Hemophilia subtype and inhibitor statusFitusiran dosing regimenAT activity level on day of or before surgery and timingType of procedurePerioperative hemostatic agent(s) usedHemostasis efficacy rating AEs in perioperative period
HA Discontinued before surgery, due to dosing hold 54.2% (at time of procedure) Laparoscopic cholecystectomy FVIII Excellent CRP increased, LDH increased 
HB with inhibitors Original dose regimen ongoing 12.3% (on day of surgery) Right ankle fusion and Achilles tendon lengthening rFVIIa Excellent None 
HA with inhibitors Paused due to surgery 17.7% (62 days before surgery) Left knee total replacement aPCC Not reported  Anemia postoperative, blood loss anemia, and post procedural edema 
HA with inhibitors Original dose regimen ongoing 13.0% (1 day before surgery) Metal plate removal and right hip total replacement aPCC Not reported  Mild postoperative hematoma reported 1 day after surgery, which required no treatment; postoperative anemia 
HA with inhibitors Original dose regimen ongoing 12.6% (1 day before surgery) Left knee total replacement aPCC Not reported  None 
HA Original dose regimen ongoing 15.0% (1 day before surgery) Nasal septoplasty FVIII Excellent None 
HA Original dose regimen ongoing 13.3% (21 days before surgery) Endoscopic Cholecystectomy FVIII Excellent None 
HA Original dose and regimen ongoing 15.7% (18 day before surgery) Extraction of two wisdom teeth None Not rated  None 
HA Original dose regimen ongoing 13.2% (3 days before surgery) Bilateral knee replacement FVIII Excellent None 
10 HB AT-based dose regimen ongoing 12.2% (2 day before surgery) Tooth extraction AT III (human) (before surgery)
Tranexamic acid (day of procedure) 
Excellent None 

Please see supplemental Table 4 in the supplemental Appendix for more detail of the hemostatic efficacy and safety of operative procedures, including a description of the dose and timing of perioperative hemostatic treatment.

aPCC, activated prothrombin complex concentrate; CRP, C-reactive protein; HA, hemophilia A; HB, hemophilia B; LDH, lactate dehydrogenase; rFVIIa, activated recombinant FVII.

The hemostatic efficacy rating of the procedure was assessed by the respective investigators.

Although the hemostatic efficacy rating was not reported for these procedures, it was noted by the investigator that each of these procedures were covered by fitusiran alone with the perioperative hemostatic plan using only reduced doses and frequency of aPCC as recommended in the bleed management dosing guidelines in the protocol. None of these procedures required AT reversal, and no excessive bleed occurred during surgeries. Thus, it was concluded that fitusiran in association with reduced dose and frequency of aPCC administered perioperatively demonstrated successful hemostatic management.

The procedure was covered by fitusiran alone without using any FVIII concentrate dose perioperatively. The procedure did not require AT reversal, and no excessive bleed occurred during the surgery. Fitusiran has demonstrated successful hemostatic management without any adjunction of FVIII concentrate perioperatively.

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