Use of prothrombin complex concentrates in management of bleeding in hemophiliacs with inhibitors--benefits and limitations.
In summary, PCCs and APCCs are moderately effective in controlling bleeding in inhibitor patients. However, they are not as effective in controlling or preventing bleeding as factor VIII (or factor IX) concentrates in hemophiliacs who do not have inhibitors. Their precise mechanism of action is still poorly understood, and there is no readily available laboratory test for monitoring patient response. While viral safety is far less of an issue with PCCs than it was a few years ago, and while thrombogenicity is far less of a problem in using PCCs and APCCs in inhibitor patients than it is in persons with hemophilia B, one must keep in mind the risk of acute myocardial infarction. Frequent, repetitive doses may be hazardous. PCCs and APCCs represent a valuable part of one's therapeutic armamentarium in managing bleeding in inhibitor patients. However, one must be aware of their limitations and potential complications, and use them appropriately.
Lusher
J M
JM
Division of Hematology/Oncology, Children's Hospital of Michigan, Detroit 48201.
D018849:Controlled Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D005164:Factor IX / Q000037:antagonists & inhibitors*; D005169:Factor VIII / Q000037:antagonists & inhibitors*; D006467:Hemophilia A / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D008991:Monitoring, Physiologic; D009203:Myocardial Infarction / Q000209:etiology; D011516:Prothrombin / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology; D014777:Virus Diseases / Q000635:transmission
D011516:Prothrombin; D005169:Factor VIII; D005164:Factor IX