The use of intermediate and high purity factor VIII products in the treatment of von Willebrand disease.
Since 1985, viral-attenuated blood products have been available for the treatment of patients with hemophilia. Unfortunately, similar viral-attenuated blood products, enriched for von Willebrand factor (vWF), have not been readily available for the treatment of patients with von Willebrand disease (vWD). In the current study, we examined the clinical efficacy and in vivo properties of two viral-attenuated factor VIII products, Koate-HS and Koate-HP, in the treatment of patients with vWD. Twenty-one (21) infusions were evaluated in 17 different vWD patients (4 with type IA; 8 with Type IIA; 1 with Type IID; 4 with type III). Seven (7) patients received Koate-HS and 12 patients received Koate-HP (2 patients received both products; 1 patient was studied three times). Von Willebrand factor antigen, ristocetin cofactor, bleeding time, and the multimeric composition of vWF were determined pre- and post-infusion. Complete or partial correction of prolonged bleeding times was observed in 2 of the 6 patients tested following treatment with Koate-HS and in 7 out of 11 patients tested following treatment with Koate-HP. Surgery was performed on five of these patients, two of whom were treated with Koate-HS and three of whom were treated with Koate-HP. In the surgical patients, clinical hemostasis was achieved regardless of whether the bleeding time was corrected. We conclude that both Koate-HS and Koate-HP can be utilized successfully in the treatment of patients with vWD in spite of the lack of high molecular weight multimers of vWF in these products.(ABSTRACT TRUNCATED AT 250 WORDS)
Hanna
W T
WT
Department of Medicine, University of Tennessee, Knoxville.
Bona
R D
RD
Zimmerman
C E
CE
Carta
C A
CA
Hebert
G Z
GZ
Rickles
F R
FR
D000293:Adolescent; D000328:Adult; D001760:Bleeding Time; D004340:Drug Contamination; D005169:Factor VIII / Q000737:chemistry / Q000302:isolation & purification / Q000627:therapeutic use*; D006487:Hemostasis / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011487:Protein Conformation; D012449:Safety; D014780:Viruses / Q000302:isolation & purification; D014842:von Willebrand Diseases / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D014841:von Willebrand Factor / Q000378:metabolism
D014841:von Willebrand Factor; D005169:Factor VIII