The Hemostatic Management by Continuous Infusion of Monoclonal Antibody-Purified Factor VIII Concentrate in the Treatment of Patients with Hemophilia A
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Continuous intravenous infusion of factor VIII (FVIII) concentrate has been reported to be effective and safe to achieve a stable plasma level of FVIII activity as well as reduction of FVIII consumption. We have used continuous infusion of a monoclonal-antibody purified FVIII concentrate (M-FVIII) for the treatment of 6 patients with hemophilia A, 5 of whom underwent major surgery and 1 with subcortical cerebral hemorrhage. The age of the patients were ranged from 16 to 68. Duration of continuous infusion was 3 to 27 days. In vitro study of the FVIII activity in the M-FVIII showed that it retained over 80% of initial FVIII activity for the period of 24 hours at room temperature in a plastic syringe. The patients required bolus shot of 63.4±29.4U/kg followed by 4.25±1.49U/kg/hr continuous infusion to keep the initial plasma factor VIII level of 100% that result in 102.3±19.0% of actual activity in the plasma of over 2 hours after starting the infusion. Subsequently, dose of continuous infusion was reduced stepwise so that the achieved plasma level of FVIII gradually decreased to 60% in 7 to 10 days after the operation, followed by bolus infusion. All the patients showed excellent hemostasis with no remarkable adverse reactions during and after the operation. 28% of the total dose of M-FVIII was reduced as compared with theoretical dose of bolus infusion of twice a day for the first 3 days. We conclude that the use of continuous infusion of M-FVIII is practical and effective replacement therapy especially for hospitalized patients with hemophilia A for elective surgery.
- 一般社団法人 日本血栓止血学会の論文
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