THE USE OF INTERMEDIATE AND HIGH-PURITY FACTOR-VIII PRODUCTS IN THE TREATMENT OF VON-WILLEBRAND DISEASE

Since 1985, viral-attenuated blood products have been avail able for t he treatment of patients with hemophilia. Unfortu nately, similar vira l-attenuated blood products, enriched for von Willebrand facto; (vWF), have not been readily available for the treatment of patients with vo n Willebrand disease (vWD). In the current study, we examined;he clini cal efficacy and in vuv properties of two viral-attenuated factor VIII products, Koate-HS and Koate-HP, in the treatment of patients with vW D. Twenty-one (21) infusions were evaluated in 17 different vWD patien ts (4 with type IA; 8 with Type IIA; 1 with Type IID; 4 with type III) . Seven (7) patients received Koate-HS and 12 patients received Koate- HP (2 patients received both products; 1 patient was studied three tim es). Von Willebrand factor antigen, ristocetin cofactor, bleeding time , and the multimeric composition of vWF were determined pre- and post- infusion. Complete or partial correction of prolonged bleeding times w as observed in 2 of the 6 patients tested following treatment with Koa te-HS and in 7 out of 11 patients tested following treatment with Koat e-HP. Surgery was performed on five of these patients, two of whom wer e treated with Koate-HS and three of whom were treated with Koate-HP. In the surgical patients, clinical hemostasis was achieved regardless of whether the bleeding time was corrected. We conclude that both Koat e-HS and Koate-HP can be utilized successfully in the treatment of pat ients with vWD in spite of the lack of high molecular weight multimers of vWF in these products. We confirm the observation that correction of the bleeding time is not an absolute necessity in order to achieve clinical hemostasis in vWD patients undergoing surgery.