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Administration and dosing schedules

Factors to consider when designing prophylaxis protocol:
  • age at which prophylaxis started
  • current age
  • venous access
  • bleeding symptoms
  • joint status
  • level and timing of physical activity
  • availability of clotting factor concentrates
  • size(s) of vials of clotting factor concentrates available

Prophylaxis is the regular infusion of clotting factor concentrates in an attempt to raise clotting factor levels and to keep them at 1% or higher at all times. There are a number of ways to achieve this; however, how it is done varies both from country to country and even within the same country.

Studies are still underway to determine the best dosing schedule (also called a ‘protocol’). A prophylaxis schedule should outline:

  • The type of factor product to be used
  • The dose of factor administered with each injection
  • The frequency at which treatment is administered
  • The time (of day, or week) that treatment is administered

There are currently two protocols in use for which there is long-term data:

  • The Malmö protocol: Injections of 25-40 IU/kg, administered three times a week for those with hemophilia A and twice a week for those with hemophilia B.
  • The Utrecht protocol: Injections of 15-30 IU/kg, administered three times a week for those with hemophilia A and twice a week for those with hemophilia B.

In countries with significant resource constraints, lower doses of prophylaxis given more frequently (e.g., 10-15 IU/kg, 3 times per week) may be an effective option.

While these are the protocols that have been studied most extensively, the ultimate protocol has not yet been defined. (See also the text on Personalized prophylaxis in the section Current Issues in Prophylaxis.)


Updated December 2014