title: Ongoing risk of thrombosis with factor XI concentrate: 5 years experience in two centres.
abstract: BACKGROUND
  Factor XI (FXI) deficiency is the commonest of the rare bleeding disorders, affecting 2079 individuals in the United Kingdom. Treatment options for bleeding or surgery include antifibrinolytics, fresh frozen plasma or plasma-derived (pd) FXI concentrates. There were a number of reports of thrombosis following treatment with FXI concentrates prior to changes in their manufacturing processes made in the mid-1990's.
  
  
  OBJECTIVE
  The aim of the study was to determine the occurrence of adverse events (haemorrhagic and thrombotic) following usage of pd-FXI concentrates at two large UK haemophilia centres. Retrospective chart review of all consecutively treated patients with BPL Factor XI(®) or Hemoleven(®) over a 5-year period (11/06-11/11) was performed.
  
  
  RESULTS
  Twenty-nine patients (median age = 57.1 years) received treatment over 64 treatment episodes (surgery = 56, bleeding = 5, other = 3), using 126 000 U of concentrate. Median baseline FXI:C was 9 U dL(-1) (range = <1-51), with 21 having severe and eight partial deficiency. BPL Factor XI(®) was used in 39 episodes (79 110 U) and Hemoleven(®) 25 episodes (46 890 U). There were six clinically significant bleeding events, managed either with a single additional dose of FXI concentrate (n = 4) or requiring no further intervention (n = 2). One patient required blood transfusion and one oral iron replacement. Two thrombotic events (transient ischaemic attack and pulmonary emboli), occurred in two patients with severe FXI deficiency, despite cautious FXI concentrate usage in the perioperative period.
  
  
  CONCLUSIONS
  FXI concentrate use is efficacious and safe in the majority of cases although physicians should remain mindful of the possibility of thrombotic complications.
authors: St George's University Hospitals NHS Foundation Trust, London, UK.|Barts and The London School of Medicine & Dentistry, The Royal London Hospital, QMUL, London, UK.
authors: P
authors: http://orcid.org/0000-0002-7808-3462
authors: P
authors: Batty
authors: Barts and The London School of Medicine & Dentistry, The Royal London Hospital, QMUL, London, UK.
authors: A
authors: A
authors: Honke
authors: The Royal London Hospital, Barts Health NHS Trust, London, UK.
authors: L
authors: L
authors: Bowles
authors: Barts and The London School of Medicine & Dentistry, The Royal London Hospital, QMUL, London, UK.
authors: D P
authors: DP
authors: Hart
authors: Barts and The London School of Medicine & Dentistry, The Royal London Hospital, QMUL, London, UK.
authors: K J
authors: KJ
authors: Pasi
authors: St George's University Hospitals NHS Foundation Trust, London, UK.
authors: J
authors: J
authors: Uprichard
authors: St George's University Hospitals NHS Foundation Trust, London, UK.
authors: S K
authors: SK
authors: Austin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002648:Child; D054796:Drug Dosage Calculations; D005172:Factor XI / Q000009:adverse effects / Q000627:therapeutic use*; D005173:Factor XI Deficiency / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D013927:Thrombosis / Q000209:etiology*; D055815:Young Adult
chemical_list: D005172:Factor XI
keywords: bleeding; factor XI; plasma-derived concentrate; surgery; thrombosis