Prevention of haemophilic synovitis: prophylaxis
C. A. LEE,
C. A. LEE
Emeritus Professor of Haemophilia, University of London and Honorary Consultant Haematologist, Oxford Haemophilia Centre, Oxford, UK
Search for more papers by this authorC. A. LEE,
C. A. LEE
Emeritus Professor of Haemophilia, University of London and Honorary Consultant Haematologist, Oxford Haemophilia Centre, Oxford, UK
Search for more papers by this authorChristine A. Lee, Emeritus Professor of Haemophilia, University of London and Honorary Consultant Haematologist, Oxford Haemophilia Centre, Oxford, UK. Tel.: +44 7977 038202; fax: +44 1865 644949; e-mail: [email protected]
C. L. declares no conflicts of interest.
Abstract
Summary. It has been proven that early prophylactic therapy can prevent bleeding and arthropathy. Numerous retrospective non-randomized cohort studies have demonstrated that prophylaxis, if started early in life, is associated with a considerable reduction of the mean number of joint bleeds and the rate of joint deterioration. It is quite extraordinary that despite the considerable evidence base it has been considered necessary by investigators to pursue the ideal of the controlled randomized trial and expose children to the risk of cerebral bleed. This questionable ethical approach is driven by the reluctance of the ‘willingness to pay’ but it is important that patients are not subjected to unnecessary investigation at either the behest of the Cochrane Database or those who control the financing of haemophilia care.
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