MULTI-CHAMBER INTRACARDIAC THROMBOSIS DURING NOVEL ORAL ANTICOAGULATION REVERSAL WITH ACTIVATED PROTHROMBIN COMPLEX CONCENTRATE INFUSION

One of us (C.F.A.) has previously reported the successful use of one of the commercially available prothrombin complex concentrates for the control of bleeding episodes of haemophiltc patients with factor VIII inhibitors. Subsequent batches of these concentrates have not proved consistently effective even in doses of 150 factor IX units/kg every 24 hours. Recently an investigational preparation, Auto Factor IX, has been made available to us. This has a stated factor VIII correctional unit assay for each batch, (based on the ability to correct the prolonged APTT of plasma containing an inhibitor of factor VIII). We used 60-120 units/kg as an IV dose every 12 or 24 hours in the treatment of 24 bleeding episodes in 8 patients with factor VIII Inhibitor. The bleeding episodes were haemarthrosis (12) soft-tissue (6) intralingual (2) lacerations (2) retroperitoneal (1) and epidural (1). Rapid easing of pain and reduction of swelling was noted in all joints and soft tissue bleeds. In the retroperitoneal bleed cessation of bleeding was demonstrated by Technetium 99 Sulfur-colloid flow study, in the patient with epidural bleeding the hematoma was shown to reduce by serial CAT scans. Response was as good as we have come to expect from similar levels of factor VIII concentrate given to patients without an inhibitor. In 23 of the 24 episodes there was a marked reduction of APTT 10 minutes after the completion of the infusion.

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Anti-inhibitor Coagulant Complex (Autoplex) for treatment of factor VIII inhibitors in hemophilia

Blood ◽

10.1182/blood.v56.6.978.978 ◽

1980 ◽

Vol 56 (6) ◽

pp. 978-984 ◽

Cited By ~ 61

Author(s):

CF Abildgaard ◽

JA Penner ◽

EJ Watson-Williams

Keyword(s):

Soft Tissue ◽

Factor Viii ◽

Prothrombin Complex Concentrate ◽

Activated Partial Thromboplastin Time ◽

Minor Bleeding ◽

Puncture Wound ◽

Monitoring Therapy ◽

Concurrent Use ◽

Activated Prothrombin Complex Concentrate ◽

Bleeding Episodes

Abstract Fourteen individuals with severe hemophilia complicated by factor VIII inhibitors (1 to 132 Bethesda Units) were treated for 33 bleeding episodes with a new activated prothrombin complex concentrate, Anti- Inhibitor Coagulant Complex (Autoplex, Hyland, Glendale, Calif.). Excellent or good results were observed in 21 of 25 minor bleeding episodes treated, which included joint, soft tissue, and mucous membrane hemorrhages. Eight major bleeding problems (an epidural bleed, a puncture wound, 2 serious soft tissue hemorrhages, 2 lacerations, and 2 major surgical procedures) were treated with excellent (6) or good (2) results. No serious complications were encountered, but two children developed transient hypofibrinogenemia following Autoplex infusion. Although some shortening of the prothrombin time and activated partial thromboplastin time was noted after infusion of Autoplex, there is no useful laboratory test for monitoring therapy. Despite the unknown mechanism of action for bypassing factor VIII, Autoplex appears to be a useful and needed interim product and is safe and effective. In view of the possible potentiation of thrombosis concurrent use of fibrinolytic inhibitors should be avoided.

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Management of haemophilia in patients with high-titre inhibitors: focus on the evolution of activated prothrombin complex concentrate AUTOPLEXR T

Haemophilia ◽

10.1046/j.1365-2516.1999.00036.x ◽

1999 ◽

Vol 5 (s3) ◽

pp. 1-9 ◽

Cited By ~ 26

Author(s):

Penner

Keyword(s):

Prothrombin Complex Concentrate ◽

High Titre ◽

Activated Prothrombin Complex Concentrate

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