Abstract
The management of hemorrhages in patients with strong inhibitors to factor VIII continues to challenge our ingenuity. No therapy stops all hemorrhages in all patients. We live with the possibility of uncontrollable bleeding. New treatment modalities are welcomed with eager hopefulness. Prothrombin complex concentrates (PCCs), usually used to treat hemophilia B (factor IX deficiency), shorten the partial thromboplastin time when added in vitro to plasma containing inhibitor to factor VIII. On the basis of this observation, PCCs were first tried in patients with critical hemorrhages in the early 1970s, with dramatic success in several instances. Purposely activated PCCs—including Autoplex, United States, and FEIBA, Austria (anti-inhibitor coagulant complex)—have a greater ability in vitro to bypass the need for factor VIII than ordinary PCCs, such as Konȳne or Proplex (factor IX complex), but all PCC products have been used extensively in patients with inhibitors. Evaluation of the efficacy of PCCs is difficult.
Published Version
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