Introduction
Severe haemophilia A is a X-linked bleeding disorder due to factor VIII
deficiency[1]. It decreases thrombin generation (TG)
potential[2]. Inhibitor[3],[4] complicated
replacement treatment (factor VIII concentrates[5]). Emicizumab
(bispecific humanized monoclonal antibody) is an effective treatment for
severe haemophilia A with inhibitor[6],[7]. It
bridges activated factor IX and X to restore missing activated factor
VIII[8]. Patients under emicizumab (Hemlibra® , Roche,
Bazel, Switzerland) bleed less than patients under bypassing agent
(BPA)[9],[10]. They still have acute bleeding
needed BPA, mainly FVIIa (Novoseven® ,rVIIa, Novonordisk,
Bagsvaerd, Denmark)[11]. Surgeries require BPA for bleeding risk but
BPA doses for patients under emicizumab are not defined. Thrombin
generation assay (TGA)[12] has been used to monitor surgery with
Novoseven® [13] and could assess haemostasis when emicizumab
and BPA are combined[14].