• Beatriz Mac Dowell Soares, Luiz Alberto Simeoni, de AlmeidaKarlo Jozefo QuadrosKJQhttp://orcid.org/0000-0001-7468-9451Hospital Regional da Asa Norte, Brasília (DF), Brazil., Jaqueline Lima de Souza, BravermanMelina SwainMShttp://orcid.org/0000-0002-2435-0596Fundação Hemocentro de Brasília, Escola Superior de Ciências da Saúde, Brasília (DF), Brazil., Alex Renner Alves Pinto, Juliana Camilo Lopes Cavaion, Lucas Barbosa Bezerra, Ana Maria Costa, and Fábio Ferreira Amorim.
• Universidade de Brasília, Programa de Pós-Graduação em Ciências da Saúde, Brasília (DF), Brazil.
• Rev Assoc Med Bras (1992). 2021 Mar 1; 67 (3): 400-405.

ObjectiveThis study aimed to analyze the compliance with the assistance protocol and factors associated with the judicialization of coagulation factors in severe hemophilia patients.MethodsA retrospective, cross-sectional study was conducted from June 2015 to May 2016 in adults with severe hemophilia in the Federal District, Brazil using data from their medical records and the Hemovida Web Coagulopathies System.ResultsOne-hundred and three patients from Federal District, the capital of Brazil, were included in the study. The mean age of the patients was 34.6±10.1. Ninety-three received prophylactic treatment (90.3%) and 53 received recombinant coagulation factors (51.7%). Judicialization occurred in 21 cases (20.4%), 13 of whom disagreed with the assistance protocol (12.6%). In the univariate analysis, an association was observed between reduced judicialization and treatment (4.8 vs. 47.6%; p<0.001) in the hemophilia treatment center and an increase that was associated with use of the recombinant coagulation factor in disagreement with the protocol (38.1 vs. 6.1%; p<0.001). In the multivariate analysis, the odds ratio for judicialization was 0.081 (95% confidence interval [CI] 0.010-0.055) for treatment at the hemophilia treatment center and 5.067 (95%CI 1.392-18.446) for the use of recombinant coagulation factor not in compliance with the protocol. More inhibitor development in judicialized patients (33.3 vs. 4.9%; p<0.001) was found.ConclusionsThe effectiveness of judicialization should be questioned, especially regarding coagulation factor prescriptions that are not in compliance with the protocol. The expense resulting from judicialization has not shown any benefit, and an even greater development of inhibitors during treatment in judicialized patients was found.

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