Tranexamic acid as adjunct therapy to bypassing agents in haemophilia A patients with inhibitors

摘要: Haemophilia patients with inhibitors require bypassing agents (BPA) like activated prothrombin complex concentrate (aPCC) and recombinant factor VII (rFVIIa) to control bleeds. Adjunct tranexamic acid (TXA) may improve haemostasis. The objective of this study was investigate safety haemostatic effect TXA given in combination BPA. Healthy volunteers (N = 5) haemophilia inhibitor (N = 6) were enrolled a prospective case crossover design. Controls treated 20 mg kg(-1) orally (O.R.) Patients aPCC 75 IU kg(-1) intravenous (I.V.) on day 1 followed by O.R. combined I.V. 2. A 14-day washout occurred before rFVIIa 90 μg kg(-1) ±TXA. Safety evaluation blood sampling processes performed at baseline, 15, 30, 60, 120, 180 240 min post treatment. Primary outcome maximum clot firmness (MCF) evaluated whole thromboelastometry using TF + tissue plasminogen activator-based assay. controls showed 20-fold increase MCF following TXA. or induced significant (P   0.05). Infusion alone only 3-10 fold from decline starting after 60-120 min. did not the endogenous thrombin potential. No clinical laboratory signs thromboembolic events, disseminated intravascular coagulation, hypercoagulability observed. Combination normalizes stability as compared healthy controls. adverse events