Treatment of inhibitor patients with activated prothrombin complex concentrates

Anti-inhibitor protease complex products have demonstrated their efficacy in controlling bleeding in non-hemophilic and hemophilic patients with inhibitors to Factor VIII and IX. Treatment programs have been identified for 1) patients who develop spontaneous, mild to moderate bleeding episodes - low dose, 30 u/Kg at 8 hour intervals; 2) surgical candidates or patients with severe bleeding and high inhibitor levels - high dose, 75-100 u/Kg at 4 to 8 hour intervals; and 3) surgical candidates with low inhibitor levels (less than 40 B.U.) - pheresis, followed by Factor VIII for 6 days, and then activated concentrates. Attempts to identify the anti-inhibitor principle in the product has led us to the conclusion that Factor X is necessary for this activity.