CONCOMITANT TREATMENT WITH FACTOR-IX CONCENTRATES AND ANTIFIBRINOLYTICS IN HEMOPHILIA-B

Concomitant use of the monoclonal antibody-purified factor IX concentr ate (Mononine, Armour Pharmaceutical Company, Collegeville, Pa.) and t wo antifibrinolytic agents, E-aminocaproic acid (EACA; Amicar, Immunex , Seattle, Wash.) or tranexamic acid (AMCA; Cyklokapron, Kabi Pharmaci a, Piscataway, N.J.) was examined for safety and efficacy in patients with hemophilia B. In a retrospective review of 19 patients treated wi th monoclonal antibody-purified factor IX and EACA on 35 occasions, bl eeding was successfully controlled and no instances of clinical thromb otic complications were reported; one instance of urticaria resolved w ithout additional treatment. The use of EACA or AMCA in combination wi th monoclonal antibody-purified factor IX was also examined prospectiv ely in a study of 9 patients. Bleeding was effectively controlled and no thrombotic events were detected clinically with either antifibrinol ytic agent. No significant changes in hematocrit or hemoglobin were de tected, and there was no evidence of thrombosis as evaluated clinicall y and by sensitive molecular markers. It was concluded from both the r etrospective and prospective data that monoclonal antibody-purified fa ctor M. concentrate in combination with an antifibrinolytic agent does not activate the coagulation cascade and is a safe and effective trea tment for prevention and control of oral bleeding in hemophilia B pati ents.