Comparison of the capacities of two prothrombin complex concentrates to restore thrombin generation in plasma from orally anticoagulated patients: an in vitro study.
BACKGROUND
Human prothrombin complex concentrates (PCCs) are used for prevention and treatment of bleeding episodes in patients under warfarin therapy. PCCs contain human factor (F) II, FVII, FIX, FX, protein C and protein S. The concentrations of these coagulation factors contained in PCCs are variable and do not reflect entirely the capacity of these drugs to correct hemostasis. Furthermore, commercially available PCCs do not have exactly the same composition, though they are all labelled and prescribed in units per kg of FIX (10-40 IU of FIX/kg). As the final product generated by PCCs is thrombin, a thrombin generation (TG) test could theoretically be used for monitoring the hemostatic correction.


METHODS
TG was measured in platelet free plasma in the presence of tissue factor 5 pm and phospholipids 4 microM with a final concentration of PCC of 0-0.1-0.2-0.3-0.4-0.5-0.75-1 IU ml(-1). The activity of vitamin K-dependent coagulation factors (i.e. FII, FVII, FIX, FX, protein C and protein S) were determined for each concentration of two different PCCs available on the French market.


CONCLUSIONS
Our results showed that the addition of two different PCCs dose-dependently increased the TG capacity in patients with INR of 2-2.5-3-4 and >7 (n = 15 subjects) that reached the normal values. We also found a significant correlation between endogenous thrombin potential (ETP) and INR (Pearson test, P < 0.0001). The two PCCs improved the TG parameters differently with increasing concentrations. The difference in the correction of TG capacity observed between the two drugs could be explained by a variable increase in FX, FVII and protein C with similar doses. These results strongly suggest that TG assay could be used for monitoring the clinical efficacy of PCC and for optimizing the therapeutic regimen towards a more individualized therapy involving the type of the bleeding complications, the level of inhibition of the coagulation system and the molecule content of the PCC.
Dargaud
Y
Y
Laboratoire d'Hémostase, Hôpital Edouard Herriot, Lyon, and EA 4174, IFR 62, Université Lyon 1, Lyon, France. ydargaud@univ-lyon1.fr
Desmurs-Clavel
H
H
Marin
S
S
Bordet
J C
JC
Poplavsky
J L
JL
Negrier
C
C
D000284:Administration, Oral; D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000737:chemistry / Q000494:pharmacology*; D001779:Blood Coagulation Factors / Q000737:chemistry* / Q000494:pharmacology*; D016022:Case-Control Studies; D004792:Enzyme Precursors / Q000737:chemistry; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D011486:Protein C / Q000737:chemistry; D013917:Thrombin / Q000096:biosynthesis / Q000737:chemistry*; D019851:Thrombophilia / Q000188:drug therapy; D014812:Vitamin K / Q000378:metabolism
D000925:Anticoagulants; D001779:Blood Coagulation Factors; D004792:Enzyme Precursors; D011486:Protein C; D014812:Vitamin K; C025667:prothrombin complex concentrates; D013917:Thrombin