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Such a prophylaxis program has been shown in relatively small cohorts to be effective in reducing bleeding occurrence, with a variable effect on the joint status, but with significantly higher factor consumption and consequently higher costs than on\u2010demand therapy. There has been no attempt to identify subsets of patients who may benefit from \u201ctertiary\u201d prophylaxis more than others, for example, due to their bleeding phenotype and\/or requirements for product issued on\u2010demand or to identify the dosage that provides the optimal balance of clinical benefit and cost effectiveness. This article reviews the published literature on prophylaxis started beyond the age of 18\u00a0years, the barriers to the uptake of prophylaxis programs particularly in adults and highlights areas in need of further research.<\/jats:p>","DOI":"10.1111\/j.1365-2516.2012.02843.x","type":"journal-article","created":{"date-parts":[[2012,5,29]],"date-time":"2012-05-29T06:21:15Z","timestamp":1338272475000},"page":"722-728","source":"Crossref","is-referenced-by-count":19,"title":["Tertiary prophylaxis in adults: is there a rationale?"],"prefix":"10.1111","volume":"18","author":[{"given":"A.","family":"Gringeri","sequence":"first","affiliation":[{"name":"Department of Medicine University of Milan, and Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Lambert","sequence":"additional","affiliation":[{"name":"Centre de Traitement des H\u00e9mophiles H\u00f4pital de Bic\u00eatre AP\u2010HP Le Kremlin Bic\u00eatre France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Street","sequence":"additional","affiliation":[{"name":"Ronald Sawers Haemophilia Centre Alfred Health Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Aledort","sequence":"additional","affiliation":[{"name":"The Mary Weinfeld Professor of Clinical Research in Hemophilia Mount Sinai School of Medicine New York NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,5,29]]},"reference":[{"key":"e_1_2_5_2_1","first-page":"1740","article-title":"Articular cartilage is more susceptible to blood induced damage at young than at old age","volume":"27","author":"Roosendaal G","year":"2000","journal-title":"J Rheumatol"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2516.2008.01882.x"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-10-050435"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-05-2008"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.1976.tb16525.x"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.1994.tb00815.x"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa067659"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2516.1998.4404214.x"},{"key":"e_1_2_5_10_1","unstructured":"National Hemophilia Foundation.MASAC Recommendations concerning prophylaxis (regular administration of clotting factor concentrate to prevent bleeding). 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