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- Title
The effects of emicizumab on in vitro coagulation and fibrinolysis parameters in patients with disseminated intravascular coagulation with and without addition of anti‐FVIII antibody.
- Authors
Onishi, Tomoko; Shimo, Hanako; Harada, Suguru; Nogami, Keiji
- Abstract
Background: Emicizumab (Emi) is used as haemostatic prophylaxis for patients with haemophilia A (PwHA). Disseminated intravascular coagulation (DIC) is a condition characterized by persistent systemic activation of coagulation, but there is yet no information on coagulation and fibrinolysis potentials in Emi‐treated PwHA with DIC. Aim: To examine the effect of Emi on coagulation and fibrinolysis potentials in HA‐model DIC plasmas. Methods: Plasma from a patient with sepsis‐DIC (seven patients) was treated with anti‐factor (F)VIII monoclonal antibody (HA‐model DIC plasma) and incubated with Emi (50 µg/mL). The plasma was then assessed using clot‐fibrinolysis waveform analysis (CFWA). Coagulation and fibrinolysis parameters were expressed as ratios relative to normal plasma (|min1|‐ratio and |FL‐min1|‐ratio, respectively). Patients and results: In case 1, coagulant potential was slightly high and fibrinolytic potential was extremely low, presenting a coagulant‐dominant state (|min1|‐ratio/|FL‐min1|‐ratio: 1.1/.38). In cases 2–5, fibrinolytic potential was not suppressed, but there were marked hypercoagulant potentials, indicating relative coagulant‐dominant states. In case 6, coagulant and fibrinolytic potentials were increased but well balanced (|min1|‐ratio/|FL‐min1|‐ratio: 1.38/1.28). In case 7, both potentials were severely deteriorated in not only CFWA but also the thrombin/plasmin generation assay. The addition of Emi into the HA‐model DIC plasmas increased |min1|‐ratio values in all cases, but the coagulant potentials did not exceed the initial ones (DIC plasma before treatment with anti‐FVIII antibody). Conclusions: The presence of Emi in the HA‐model DIC plasma improved coagulation potentials, but did not increase coagulation potentials beyond those of DIC plasma in non‐HA states.
- Subjects
EMICIZUMAB; FIBRINOLYSIS; BLOOD coagulation; HEMOPHILIACS; WAVE analysis; DISSEMINATED intravascular coagulation
- Publication
Haemophilia, 2024, Vol 30, Issue 3, p836
- ISSN
1351-8216
- Publication type
Article
- DOI
10.1111/hae.14997