Management and monitoring of recombinant activated factor VII

Ingerslev, Jørgen; Christiansen, Karl O.; Calatzis, Andreas; Holm, M.O.; Ebbesen, Liselotte S.

doi:10.1097/00001721-200004001-00006

Cited by 40 publications

(37 citation statements)

References 12 publications

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“…Previous publications from our laboratory have documented the utility of the modified thrombelastographic analysis utilizing activation with minute amounts of tissue factor and dynamic parameters that enhance interpretation of the kinetic properties of clot formation in haemorrhagic disorders [6,8,12]. In the present study, using an identical assay setup, a certain degree of hypercoagulation was detected in a group of unselected thrombosis-prone patients.…”

Section: Discussionsupporting

confidence: 51%

Whole blood thrombelastographic coagulation profiles using minimal tissue factor activation can display hypercoagulation in thrombosis‐prone patients

Poulsen

Christiansen

Sørensen

et al. 2006

Scandinavian Journal of Clinical and Laboratory Investigation

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Section: Discussionsupporting

confidence: 51%

Whole blood thrombelastographic coagulation profiles using minimal tissue factor activation can display hypercoagulation in thrombosis‐prone patients

Poulsen

Christiansen

Sørensen

et al. 2006

Scandinavian Journal of Clinical and Laboratory Investigation

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“…The doses of rVIIa given, time intervals between doses, other treatments such as antifibrinolytics and transfusions and the use of compression and/or topical adrenaline, were also recorded. Pre-and post PFA 100 TM (platelet function analyser) (Dade-Behring, Deerfield, IL, USA) closure times (CT) were done in six episodes (Ingerslev et al, 2000), and the prothrombin time was measured preand post rVIIa at least once in each child.…”

Section: Methodsmentioning

confidence: 99%

“…closure times may be helpful (Hedner, 1996) but, in our hands and with only small numbers, these did not correlate with clinical response; there was no difference in the closure times and the PT was shortened by rVIIa when measured in all patients. The use of FVII coagulant activity (FVII:C) assays shows that the FVII:C level becomes supra-physiological but these results are not necessarily helpful in guiding dosing (Johannessen et al, 2000;Wong et al, 2002) There has been recent interest in the use of the thromboelastogram for monitoring response but more data on this are required (Ingerslev et al, 2000;Monte & Lyons, 2002).…”

Section: Rviia In Children With Platelet Function Disordersmentioning

confidence: 99%

The use of recombinant factor VIIa in children with inherited platelet function disorders

et al. 2003

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Summary. Inherited deficiencies of platelet surface glycoproteins such as Glanzmann's thrombasthenia (GT) or Bernard–Soulier syndrome (BSS) can lead to a severe bleeding diathesis. In the past, bleeding episodes in these patients have often required platelet transfusion to secure haemostasis but recently a number of patient reports have suggested that recombinant factor VIIa (rVIIa) may also be effective. We have used rVIIa on 33 occasions in seven children with inherited platelet function disorders over a 2‐year period: five had GT, one had BSS and one had storage pool disease with a severe phenotype. Bleeding ceased with rVIIa alone in 10 of 28 acute bleeding episodes, but recurred in two of these. The two features that predicted response to rVIIa were the severity of the bleeding and the delay from the onset of bleeding to treatment. Five episodes of planned surgical intervention were treated successfully with rVIIa. Eighteen out of the 28 acute episodes and none of the planned surgical episodes required blood product support. We have found variable efficacy of rVIIa for acute bleeding episodes in this small series of children with inherited platelet function defects but larger studies are warranted, particularly as rVIIa is a relatively low‐risk treatment approach for these disorders.

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“…There is no routine test that quantitatively assesses the thrombin forming capacity of a plasma sample. General clotting tests such as prothrombin time, activated partial thromboplastin time and the thromboelastogram [9,10] do not reflect overall TG and are insensitive to hypercoagulation and possibly also hypocoagulation.…”

Section: Introductionmentioning

confidence: 99%

Factor VIII Inhibitor-Bypassing Agents Act by Inducing Thrombin Generation and Can Be Monitored by a Thrombin Generation Assay

Turecek

Váradi

Keil

et al. 2003

Pathophysiol Haemos Thromb

111

110

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Factor VIII (FVIII)-bypassing agents have complex modes of action but all control bleeding in inhibitor patients by triggering the generation of thrombin. No routine test is available for monitoring this therapy in patients with inhibitors against FVIII. We present an assay that records FEIBA- or FVIIa-mediated changes in thrombin generation (TG) in FVIII inhibitor plasma samples. In plasma samples spiked with FEIBA TG was normalized above 0.4 U/ml, while for recombinant FVIIa (rFVIIa) more than 12.5 µg/ml were required to induce TG in the absence of tissue factor (TF). Addition of TF increased the TG potential of rFVIIa in vitro. This assay seems suitable for monitoring the pharmacokinetics of inhibitor bypassing agents during treatment and possibly for predicting responses to treatment.

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Management and monitoring of recombinant activated factor VII

Cited by 40 publications

References 12 publications

Whole blood thrombelastographic coagulation profiles using minimal tissue factor activation can display hypercoagulation in thrombosis‐prone patients

Whole blood thrombelastographic coagulation profiles using minimal tissue factor activation can display hypercoagulation in thrombosis‐prone patients

The use of recombinant factor VIIa in children with inherited platelet function disorders

Factor VIII Inhibitor-Bypassing Agents Act by Inducing Thrombin Generation and Can Be Monitored by a Thrombin Generation Assay

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