She was treated with FFP, PCC and rFVIIa on numerous occasions. At presentation she
reported pain and swelling in the right ankle which did not resolve after conservative treatment. The ROM of the joint was reduced. The magnetic resonance imaging (MRI) and computed tomography (CT) scans showed a periarticular cyst of the distal tibia with possible penetration selleck chemicals to the ankle joint. The surgical procedure consisted in ankle arthroscopy, removal of the cyst and placement of bone substitute into the bone deficit. What was interesting was, arthroscopic inspection revealed unaffected joint cartilage and synovium. On D0 the patient received 37 μg kg−1 of rFVIIa every 8 h (first dose just prior to surgery), then 37 μg kg−1 of rFVIIa every 12 h through D1-D4 and 29.6 μg kg−1 every 24 h through D5–D9 after surgery (Table 2). FVII:C trough plasma levels in the post-operative period ranged from 5 (D6) to RO4929097 chemical structure 36 IU dL−1 (D1). Higher- than- scheduled doses of rFVIIa resulted from the simple fact that only two potencies of rFVIIa (2 and 5 mg per bottle) were available in our Centre at the time of surgery. No bleeding complications were observed. Total blood loss was 30 mL. Thromboprophylaxis was not given. The postoperative pain was mild and resolved after physiotherapy.
The patient was discharged on day 11 after surgery. Eight months after surgery there was full range of ankle movement and the patient reported merely mild pain after strenuous activity. Patient no 05 is a 66-year-old woman with FVII-baseline activity
8 IU dL−1 and negative personal history of unprovoked bleeds. She had undergone several surgical procedures under haemostatic cover of various FVII-containing preparations (FFP, PCC and rFVIIa). Concomitant diseases are: arterial hypertension, ischaemic heart disease and Graves-Basedov disease. At presentation, she reported pain and clicking in her right knee as a result of injury that had taken place several months earlier. X-ray imaging revealed no changes. However, MRI showed a tear in the lateral meniscus and small chondral deficit in the lateral compartment of the right knee. We performed arthroscopic surgery with partial meniscectomy and shaving 4-Aminobutyrate aminotransferase of the cartilage deficit with microfractures. Just prior to surgery, on D0, the patient received 25 μg kg−1 of rFVIIa. On the same day two additional doses of rFVIIa 12.5 μg kg−1 were administered 8 and 16 h later. She was then given 12.5 μg kg−1 of rFVIIa every 12 h through D1–D4 and every 24 h through D5–D9 after surgery (Table 2). FVII:C trough plasma levels in the post-operative period ranged from 8 (D9) to 25 IU dL−1 (D5) (D1 – 18 IU dL−1). The post-op period was uneventful. Total blood loss was 110 mL. Thromboprophylaxis was not utilized. Physiotherapy with non-weight-bearing protocol was started immediately. The patient was discharged 12 days after surgery. Weight-bearing was allowed 6 weeks after surgery.