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Master Thesis

Patients hémophiles A sévères traités par Emicizumab (HEMLIBRA®) : quid de l’anticoagulation

Abstract : Anticoagulation of patients with hemophilia is a challenge due to the difficulty in obtaining therapeutic efficacy without bleeding complications in patients at risk of bleeding. Some new treatment such as Emicizumab arrived but are associated, in few cases, with more thrombotic complications. Initiation of anticoagulant therapy complicates the management of these patients and laboratory monitoring is more difficult because of many interferences of Emicizumab on the tests commonly used in the laboratory. We also supposed that Emicizumab could interfere with the anticoagulant effect of classical molecules. The main objective was to assess, in patients with severe hemophilia A, the impact of a treatment with Emicizumab (HEMLIBRA®) on the anticoagulant effect of molecules commonly used in the treatment of VTE, with thrombin generation assays. Our results showed the procoagulant effect of Emicizumab when added to a FVIII-deficient plasma by an increasing of thrombin generation in a concentration-dependent manner. The restoration of a clotting potential is equivalent to a plasma containing 10% to 20% of FVIII. The addition of Emicizumab to a FVIIIdeficient plasma, prior to the addition of different anticoagulants did not alter the anticoagulant effect of these molecules in vitro. To our knowledge, this is the first time that thrombin generation assays have been used to measure the effect of Emicizumab, when added to a FVIII-deficient plasma, on the anticoagulant effect of molecules used in the treatment of VTE. We hypothesize that these treatments could be used in patients with severe hemophilia A treated with Emicizumab with the same dosages as patients without hemophilia. However, the same precautions, including an assessment of the benefit/risk ratio for the use of these molecules, remain essential. Further studies are needed to see if similar results can be observed in vivo.
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Master Thesis
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Submitted on : Friday, September 3, 2021 - 11:49:31 AM
Last modification on : Tuesday, October 19, 2021 - 11:34:51 PM
Long-term archiving on: : Saturday, December 4, 2021 - 6:56:01 PM


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Bettina Leroy. Patients hémophiles A sévères traités par Emicizumab (HEMLIBRA®) : quid de l’anticoagulation. Médecine humaine et pathologie. 2021. ⟨dumas-03333867⟩



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