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- Title
Expert United Kingdom consensus on the preservation of joint health in people with moderate and severe haemophilia A: A modified Delphi panel.
- Authors
Laffan, Mike; McLaughlin, Paul; Motwani, Jayashree; Alamelu, Jayanthi; Austin, Steve; Classey, Stephen; Dolan, Gerard; Eales, Marie; Gooding, Richard; Grainger, John; Harrison, Catherine; Jones, April; Kelly, Anne M.; Oyesiku, Lara; Rodgers, Ryan; Stephensen, David; Talks, Kate; Sonecha, Shaneil; Danquah, Andrew
- Abstract
Aim: For people with haemophilia A (PwHA), bleeding in the joints leads to joint damage and haemophilia‐related arthropathy, impacting range of motion and life expectancy. Existing guidelines for managing haemophilia A support healthcare professionals (HCPs) and PwHA in their efforts to preserve joint health. However, such guidance should be reviewed, considering emerging evidence and consensus as presented in this manuscript. Methods: Fifteen HCPs experienced in the management of PwHA in the UK participated in a three‐round Delphi panel. Consensus was defined at ≥70% of panellists agreeing or disagreeing for Likert‐scale questions, and ≥70% selecting the same option for multiple‐ or single‐choice questions. Questions not reaching consensus were revised for the next round. Results: 26.8% (11/41), 44.8% (13/29) and 93.3% (14/15) of statements reached consensus in Rounds 1, 2 and 3, respectively. HCPs agreed that prophylaxis should be offered to patients with a baseline factor VIII (FVIII) level of ≤5 IU/dL and that, where there is no treatment burden, the aim of prophylaxis should be to achieve a trough FVIII level ≥15 IU/dL and maintain a longer period with FVIII levels of ≥20–30 IU/dL to provide better bleed protection. The aspirational goal for PwHA is to prevent all joint bleeds, which may be achieved by maintaining normalised (50–150 IU/dL) FVIII levels. Conclusion: The panel of experts were largely aligned on approaches to preserving joint health in PwHA, and this consensus may help guide HCPs.
- Subjects
UNITED Kingdom; JOINTS (Anatomy); HEMOPHILIA; MEDICAL personnel; BLOOD coagulation factor VIII; RANGE of motion of joints; CHARCOT joints
- Publication
Haemophilia, 2024, Vol 30, Issue 2, p306
- ISSN
1351-8216
- Publication type
Article
- DOI
10.1111/hae.14934