The effects of emicizumab on in vitro coagulation and fibrinolysis parameters in patients with disseminated intravascular coagulation with and without addition of anti-FVIII antibody.

Autor: Onishi T; Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan.; Center of Postgraduate Training Nara Medical University Hospital, Kashihara, Nara, Japan., Shimo H; Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan., Harada S; Chugai Pharmaceutical Co., Ltd, Yokohama, Kanagawa, Japan., Nogami K; Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan.
Jazyk: angličtina
Zdroj: Haemophilia : the official journal of the World Federation of Hemophilia [Haemophilia] 2024 May; Vol. 30 (3), pp. 836-844. Date of Electronic Publication: 2024 Mar 24.
DOI: 10.1111/hae.14997
Abstrakt: Background: Emicizumab (Emi) is used as haemostatic prophylaxis for patients with haemophilia A (PwHA). Disseminated intravascular coagulation (DIC) is a condition characterized by persistent systemic activation of coagulation, but there is yet no information on coagulation and fibrinolysis potentials in Emi-treated PwHA with DIC.
Aim: To examine the effect of Emi on coagulation and fibrinolysis potentials in HA-model DIC plasmas.
Methods: Plasma from a patient with sepsis-DIC (seven patients) was treated with anti-factor (F)VIII monoclonal antibody (HA-model DIC plasma) and incubated with Emi (50 µg/mL). The plasma was then assessed using clot-fibrinolysis waveform analysis (CFWA). Coagulation and fibrinolysis parameters were expressed as ratios relative to normal plasma (|min1|-ratio and |FL-min1|-ratio, respectively).
Patients and Results: In case 1, coagulant potential was slightly high and fibrinolytic potential was extremely low, presenting a coagulant-dominant state (|min1|-ratio/|FL-min1|-ratio: 1.1/.38). In cases 2-5, fibrinolytic potential was not suppressed, but there were marked hypercoagulant potentials, indicating relative coagulant-dominant states. In case 6, coagulant and fibrinolytic potentials were increased but well balanced (|min1|-ratio/|FL-min1|-ratio: 1.38/1.28). In case 7, both potentials were severely deteriorated in not only CFWA but also the thrombin/plasmin generation assay. The addition of Emi into the HA-model DIC plasmas increased |min1|-ratio values in all cases, but the coagulant potentials did not exceed the initial ones (DIC plasma before treatment with anti-FVIII antibody).
Conclusions: The presence of Emi in the HA-model DIC plasma improved coagulation potentials, but did not increase coagulation potentials beyond those of DIC plasma in non-HA states.
(© 2024 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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