Rehabilitation in haemophilic children with inhibitors using recombinant activated factor VII

Abstract

INTRODUCTION: During invasive and orthopaedic procedure of the joints, physical therapy is a necessary modality for successful recovery, especially in patients with haemophilia. These patients require concurrent substitution therapy. Recombinant activated factor VII (rFVIIa) has been successfully used in treating haemophilia with inhibitor, especially during preoperative preparation. Nevertheless, optimal substitution therapy during perioperative physical therapy has been poorly defined. CASE OUTLINE: In our paper, we review the literature and the course of perioperative rehabilitation after synovectomy in a 16-year-old haemophilic patient with high-titre inhibitor, treated with rFVIIa. Rehabilitation was started on day 3 after surgery, with rFVIIa substitution lasting ten days and followed by intermittent dosages during episodes of pain. After concluding physical treatment, a significantly better function of the operated joint was recorded, which led to the recovery of walking without orthopaedic aid. CONCLUSION: Patients with inhibitors require individualized approach of a multidisciplinary team in order to achieve optimal results in elective orthopaedic procedures.