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PM Mannucci, KA Bauer, A Gringeri, S Barzegar, B Bottasso, L Simoni and RD Rosenberg
A. Bianchi Bonomi Hemophilia and Thrombosis Center, University of Milan,
Italy.
Prothrombin complex concentrates (PCC), licensed for the treatment of
hemophilia B, are known to carry a significant risk of thromboembolic
complications. Although the reasons for thrombogenicity are not completely
understood, several manufacturers have developed purified factor IX
concentrates that contain negligible amounts of the other vitamin
K-dependent factors. To evaluate whether or not the infusion of such a
factor IX concentrate is followed by lesser activation of the hemostatic
system than by the infusion of a PCC, we performed a series of coagulation
assays on 11 hemophilia B patients before and after the administration of
these two types of concentrate using a randomized cross-over design. The
levels of prothrombin fragment F1 + 2, a sensitive measure of the in vivo
cleavage of prothrombin by factor Xa, was significantly increased in plasma
after PCC, but not after factor IX concentrate. Plasma fibrinopeptide A, a
sensitive index of the enzymatic activity of thrombin on fibrinogen, also
increased significantly after PCC but not after factor IX concentrate. The
fragment B beta 15-42, a sensitive index of the enzymatic action of plasmin
on fibrin II, did not change after either concentrate. There were also no
differences in less sensitive coagulation measurements, such as plasma
fibrinogen, antithrombin III, and fibrin monomers, nor in indices of
platelet activation, such as beta-thromboglobulin and platelet factor 4.
These findings show that the infusion of a purified factor IX concentrate
can result in substantially less activation of the coagulation cascade than
may be seen with PCC.
This article has been cited by other articles:
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| Copyright © 1990 by American Society of Hematology Online ISSN: 1528-0020 | |||||||||
