Failure of Activated Prothrombin Complex Concentrates in a Hemophiliac With an Anti-Factor VIII Antibody

IN APPROXIMATELY 15% of patients with severe hemophilia A who receive multiple transfusions, anti— factor VIII antibodies develop (C. W. McMillan, MD, S. S. Shapiro, MD, J. Lazerson, MD, unpublished data, 1983). Control of hemorrhagic episodes in these patients is often difficult and unsatisfactory. Various methods of treatment have been developed for such patients.¹,²Most recently, activated prothrombin complex concentrates (PCCs) have been described as efficacious in controlling hemorrhage in patients with an inhibitor. Two preparations of activated PCC have been developed: Autoplex (anti-inhibitor coagulant complex) and FEIBA (factor eight inhibitor bypassing activity). In published trials, response to treatment with Autoplex for major and minor bleeds ranged from excellent to fair with no treatment failures,²while FEIBA was judged to be effective in control of joint and muscle bleeding in 64% of treatment episodes.³The purpose of this report is to describe the failure of Autoplex to