Recombinant VIIa concentrate in the management of bleeding following prothrombin complex concentrate-related myocardial infarction in patients with haemophilia and inhibitors

Prothrombin complex concentrates (PCCs) and, more recently, activated proth rombin complex concentrates (APCCs), are widely used for the treatment of a ctive bleeding in haemophiliacs with inhibitors. Myocardial infarction (MI) , associated with the use of these concentrates, is a well-recognized, but uncommon, complication. We review the 14 previous cases published in the li terature and describe two additional patients. MI related to the use of act ivated and non-activated PCCs predominantly affects young patients who ofte n have no preceding history of, or risk factors for, MI and tends to be ass ociated with large cumulative doses of concentrate. The most frequent patho logical finding is myocardial haemorrhage, with no evidence of coronary art ery atheroma or thrombosis. The management of further bleeding in these pat ients is difficult. We have safely used recombinant factor VIIa to treat bl eeding in the immediate and long-term period following PCC-related MI.