Deciding About Surgery

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For hemophilia patients with inhibitors, surgery for joints damaged by bleeds is the most commonly recommended surgical procedure. This type of elective orthopedic surgery (EOS) may help increase range of motion as well as provide relief from the pain or discomfort of the condition.

In order to consider all the issues and make the decision that will work best for you, it is helpful to ask questions of your hematologist, your surgeon, your physical therapist, and yourself.

Start by asking yourself the following questions:

What is my condition?
How is my condition affecting my life?
Am I in severe pain or discomfort?
Is my condition affecting how I want to live?
What will my life be like if I don't have surgery?
Are the potential benefits of surgery worth the potential risks?

It's important to understand as much about the procedure as possible. Here is a list of questions to ask a hematologist and the surgeon:

What surgical procedure are you recommending?
Why do I need the procedure?
Are there other ways to treat this condition without having this procedure?
How will this procedure benefit me?
What are the risks of having this procedure?
What will happen if I don't have this procedure?
How common is this procedure?
What is the success rate for people who have hemophilia with inhibitors?
Is the surgeon experienced in operating on people with hemophilia with inhibitors?
Will there be a hematologist involved?
How will bleeding be controlled?
Where will I have the procedure?
Will I be given anesthesia?

It's also important to know what to expect after the surgery. Here is a list of questions to ask the hematologist, surgeon, and physical therapist:

How long will it take to recover from the anesthesia?
How long will it take to rehabilitate and return to normal activities?
How often will physical therapy be scheduled?
How long will I be in the hospital?
What is the goal of physical therapy?
What kind of range of motion can I expect to regain?

INDICATIONS

NovoSeven^® RT is indicated for the treatment of bleeding episodes in hemophilia A or B patients with inhibitors to FVIII or FIX and in patients with acquired hemophilia; prevention of bleeding in surgical interventions or invasive procedures in hemophilia A or B patients with inhibitors to FVIII or FIX and in patients with acquired hemophilia; treatment of bleeding episodes in patients with congenital Factor VII deficiency and prevention of bleeding in surgical interventions or invasive procedures in patients with congenital FVII deficiency.

IMPORTANT SAFETY INFORMATION

The most common side effects in people taking rFVIIa were fever, bleeding, injection site reaction, joint pain, headache, hypertension, hypotension, nausea, vomiting, pain, swelling, and rash.
After taking rFVIIa, some patients have more of a risk of thrombosis, which is when a clot forms in a blood vessel and causes harm. Although the extent of this risk is not known, it is thought to be small. Some patients have conditions that may increase this risk. These include clogged arteries, blood clots that form throughout the body instead of at the place of injury, a type of blood poisoning called septicemia, and crush injury, which is when a body part is crushed or squeezed between heavy or immobile objects. Also, people taking aPCCs/PCCs (activated or nonactivated prothrombin complex concentrates) at the same time that they are taking NovoSeven^® RT may be at increased risk for thrombosis.
People who have ever had a bad reaction to proteins from mice, hamsters, or "bovines" (such as an ox or cow) should consult their physician prior to using NovoSeven^® RT.
Serious adverse events which may or may not have been related to the use of rFVIIa occurred in 14 of the 298 patients in the initial clinical program.
There have been no reports of rFVIIa causing bad reactions to "analgesics" (such as pain killers), "antibiotics" (the drugs used to treat infection), or "sedatives" (sleeping pills or tranquilizers).
Some patients with Factor VII deficiency have developed resistance (antibodies) to Factor VII after treatment with rFVIIa. These patients had been previously treated with human plasma and/or plasma-derived Factor VII.
Use of NovoSeven^® RT with other formulations of rFVIIa is not recommended due to potential dosing errors resulting from different concentrations.

Please click here for NovoSeven^® RT Prescribing Information

Please click here for original NovoSeven^® Prescribing Information

Novo Nordisk is a registered trademark of Novo Nordisk A/S.
NovoSeven is a registered trademark of Novo Nordisk Health Care AG.
© 2008 Novo Nordisk Inc. 135550 June 2008