An 18-year-old hemophiliac with factor VIII-inhibitor was admitted to our hospital with 4 episodes of intracranial bleeding for the past 2 years. The initial episode of bleeding dated at Sep. 1, 1980 was successfully treated with a preparation of activated prothrombin complex concentrate (PCC), FEIBA, as described in Thromb. Res. 22, 177, 1981. We also discussed some problems including clinical efficacy, monitoring for hemostasis and thromboembolic complications. The conclusion led us to an emphasis that nonactivated-partial thromboplastin time (NA-PTT) and r-value on thrombelastogram (TEG) were important for monitoring.
Since then, the last 3 episodes of bleeding developed successively in a short period of 6 months, were all treated as follows: On the 1st and 2nd bleeding, a nonactivated PCC (Konyne) was used initially, but the clinical and laboratory improvement was hardly shown. So, an activated PCC (Autoplex) was introduced instead, and it gave dramatic effects on both bleeding. The stortening of NA-PTT and r-value on TEG were recorded for about 8 hours after injection, and the maximum effect was shown after 2 hours. For the 3rd episode, medical treatment started with another nonactivated PCC (Proplex), and the clinical and laboratory improvement was noted, but lesser improvement was observed with Proplex. Any thromboembolic complications were not observed through the above 3 episodes.
