CO-23 | PERIOPERATIVE MANAGEMENT OF MILD-TO-MODERATE HEMOPHILIA: A COMPARATIVE STUDY OF EXTENDED HALF-LIFE VERSUS STANDARD HALF-LIFE CONCENTRATES ON CLINICAL OUTCOMES AND FACTOR CONSUMPTION

M. Capetta^1|2|3, F. Valeri^1|2, C. Dainese^1|2, S. Bergonzi^1|2|3, G. Murante^1|2|3, A. Valpreda⁴, R. Pastorino^1|3, F. Bocchi^1|3, B. Bruno^2|3, A. Borchiellini^1|2 | ¹Regional Centre for Hemorrhagic and Thrombotic Diseases, AOU Città della Salute e della Scienza, Torino, Italy; ²Division of Hematology, AOU Città della Salute e della Scienza, University of Turin, Italy; ³Department of Molecular Biotechnology and Health Sciences, University of Turin, Italy; ⁴Central Laboratory Baldi and Riberi, AOU Città della Salute e della Scienza, University of Turin, Italy

Background and Aims. In recent years, extended half-life concentrates (EHLs) have become an effective alternative to standard half-life concentrates (SHLs) in hemophilia, offering improved pharmacokinetics and reduced infusion frequency. These features make EHLs particularly attractive for perioperative management. While their efficacy and safety in surgery have been confirmed in severe or moderate-severe hemophilia, evidence remains scarce for mild-to-moderate hemophilia. The aim of this study was to confirm perioperative safety and hemostatic efficacy of EHLs and to evaluate the reduction of factor consumption and number of infusions of EHLs compared to SHLs in patients with mild-to-moderate hemophilia A (HA) or B (HB).
Materials and Methods. We retrospectively analyzed 191 patients with mild-to-moderate HA or HB and collected data from 27 EHL-managed surgeries (14 major, 13 minor) performed at our center between 2018 and 2026 on 22 patients (20 mild, 2 moderate). Two patients underwent the same surgery with both SHLs and EHLs, allowing an intra-patient comparison. Data were also compared with published literature for the same procedures (direct comparison of major surgeries was not possible due to the lack of comparable literature data). Preoperative PK studies guided dosing strategies in 16 procedures (59%), maintaining mean trough levels of 55% (24h) and 31% (72h); two emergency major surgeries precluded PK analysis. Regarding patients with HA, 11 procedures were performed using turoctocog alfa pegol, 4 with rurioctocog alfa pegol, 1 with damoctocog alfa pegol. Among patients with HB, nonacog beta pegol was utilized in 6 cases, eftrenonacog alfa and albutrepenonacog alfa in 2 cases each.
Results. In both comparisons we observed a reduction in the number of infusions (Table 1a) and total factor consumption (Table 1a, Table 1b). All 27 surgeries were managed with a single preoperative infusion. Postoperative infusions were administered once daily, whereas the literature reports twice-daily infusions when using SHLs. The sole exception in our cohort was a patient with mild HA undergoing cardiac surgery, who required more frequent infusions within the first 24 hours post-surgery before early transition to a single daily infusion. No patients developed inhibitors; a single bleeding event was due to poor hemostasis.
Conclusions. EHLs appear safe and effective for surgery in mild-to-moderate hemophilia, offering clinical advantages over SHLs across all analyzed populations, particularly in HB. While not statistically significant due to the limited cohort, these findings demonstrate a clinical advantage, despite the absence of baseline factor levels for literature-based cases. For HA, further improvements are expected with the advent of newer molecules.