The Role of Prothrombin Complex Concentrates In the Treatment of Hemophiliacs with Factor VIII Inhibitors

While the presence of a Factor VIII inhibitor does not increase the frequency of bleeding, it does make treatment of bleeding episodes difficult. Over the past decade prothrombin complex concentrates (PCC) have been used in an attempt to bypass the need for Factor VIII. While their precise mechanism of action is still not known, PCC do seem to be moderately effective in controlling bleeding in hemophiliacs with inhibitors. In each of three controlled double blind studies a single dose of non‐activated PCC was found to be effective in controlling acute hemarthroses in approximately 50% of episodes. While FEIBA was found to be somewhat more effective (64%) than non‐activated PCC (52%) in the Dutch trial, in the only controlled trial in which a single dose of Autoplex was compared to a single dose of non‐activated PCC there was no difference between the two products. Nonetheless a number of independent observers have noted beneficial effects when activated PCC have been used in serious, life threatening types of bleeding. Thus, until a more predictably effective therapeutic modality becomes available, PCC, both non‐activated and activated, have a definite role in the management of patients with inhibitors.