Summary of surgical procedures performed during trial
Surgery no. . | Hemophilia subtype and inhibitor status . | Fitusiran dosing regimen . | AT activity level on day of or before surgery and timing . | Type of procedure . | Perioperative hemostatic agent(s) used . | Hemostasis efficacy rating∗ . | AEs in perioperative period . |
---|---|---|---|---|---|---|---|
1 | HA | Discontinued before surgery, due to dosing hold | 54.2% (at time of procedure) | Laparoscopic cholecystectomy | FVIII | Excellent | CRP increased, LDH increased |
2 | HB with inhibitors | Original dose regimen ongoing | 12.3% (on day of surgery) | Right ankle fusion and Achilles tendon lengthening | rFVIIa | Excellent | None |
3 | 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 |
4 | 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 |
5 | HA with inhibitors | Original dose regimen ongoing | 12.6% (1 day before surgery) | Left knee total replacement | aPCC | Not reported† | None |
6 | HA | Original dose regimen ongoing | 15.0% (1 day before surgery) | Nasal septoplasty | FVIII | Excellent | None |
7 | HA | Original dose regimen ongoing | 13.3% (21 days before surgery) | Endoscopic Cholecystectomy | FVIII | Excellent | None |
8 | HA | Original dose and regimen ongoing | 15.7% (18 day before surgery) | Extraction of two wisdom teeth | None | Not rated‡ | None |
9 | 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 status . | Fitusiran dosing regimen . | AT activity level on day of or before surgery and timing . | Type of procedure . | Perioperative hemostatic agent(s) used . | Hemostasis efficacy rating∗ . | AEs in perioperative period . |
---|---|---|---|---|---|---|---|
1 | HA | Discontinued before surgery, due to dosing hold | 54.2% (at time of procedure) | Laparoscopic cholecystectomy | FVIII | Excellent | CRP increased, LDH increased |
2 | HB with inhibitors | Original dose regimen ongoing | 12.3% (on day of surgery) | Right ankle fusion and Achilles tendon lengthening | rFVIIa | Excellent | None |
3 | 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 |
4 | 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 |
5 | HA with inhibitors | Original dose regimen ongoing | 12.6% (1 day before surgery) | Left knee total replacement | aPCC | Not reported† | None |
6 | HA | Original dose regimen ongoing | 15.0% (1 day before surgery) | Nasal septoplasty | FVIII | Excellent | None |
7 | HA | Original dose regimen ongoing | 13.3% (21 days before surgery) | Endoscopic Cholecystectomy | FVIII | Excellent | None |
8 | HA | Original dose and regimen ongoing | 15.7% (18 day before surgery) | Extraction of two wisdom teeth | None | Not rated‡ | None |
9 | 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.