Prevention of haemophilic arthropathy in haemophilic children with inhibitors

Prophylaxis is the ideal manner to treat haemophilia patients without inhibitors. In fact, it can prevent the orthopaedic complications that commonly bedevil haemophilia patients without inhibitors in the absence of such prophylaxis or when they are only managed by on-demand treatment. Currently, there are two agents that allow us to control haemostasis in patients with inhibitors, i.e. recombinant factor VIIa (rFVIIa) and activated prothrombin complex concentrate (APCC). Both agents can be used for arthropathy prevention, or for intensive on-demand treatment in haemophilia patients with inhibitors. In this paper, we have tried to find an answer to the question of which bypassing agents (rFVIIa or APCC) could be used in children and adults.