Abstract | INTRODUCTION: MATERIAL AND METHODS: Eleven patients with severe haemophilia A with inhibitors who are on emicizumab were recruited to participate. Blood samples drawn from patients were spiked in vitro with varying concentrations of aPCC and rFVIIa. All samples were tested utilizing global haemostasis assays, thromboelastography and thrombin generation assay. RESULTS:
Thrombin generation increased with higher concentrations of spiked BPA with a normalized endogenous thrombin potential at a concentration of 0.05 IU/ml and 4 mcg/ml for aPCC and rFVIIa, respectively. Concentrations of aPCC in the range of licensed dosing led to excessive thrombin generation. Thromboelastography was not sufficiently sensitive. CONCLUSION: Due to the known thrombotic complications when emicizumab is used in conjunction with aPCC, there has been a large-scale abandonment of the use of aPCC in patients on emicizumab. However, it is possible that aPCC can be used safely with emicizumab albeit with lower doses than are typically prescribed. It would be important to test this hypothesis in a clinical study.
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Authors | Hande Kizilocak, Elizabeth Marquez-Casas, Choo Phei Wee, Jemily Malvar, Roxana Carmona, Guy Young |
Journal | Haemophilia : the official journal of the World Federation of Hemophilia
(Haemophilia)
Vol. 27
Issue 1
Pg. 164-172
(Jan 2021)
ISSN: 1365-2516 [Electronic] England |
PMID | 33245833
(Publication Type: Journal Article)
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Copyright | © 2020 John Wiley & Sons Ltd. |
Chemical References |
- Antibodies, Bispecific
- Antibodies, Monoclonal, Humanized
- Blood Coagulation Factors
- Recombinant Proteins
- emicizumab
|
Topics |
- Antibodies, Bispecific
(pharmacology, therapeutic use)
- Antibodies, Monoclonal, Humanized
(therapeutic use)
- Blood Coagulation Factors
- Hemophilia A
(drug therapy)
- Hemostasis
- Humans
- Recombinant Proteins
|