Evaluation of rFVIIa (NovoSeven) in Glanzmann patients with thromboelastogram

Glanzmann thrombasthenia (GT) is a rare platelet function disorder characterized by a defect in fibrinogen binding to platelet membrane glycoprotein (GP) IIb/IIIa. Recombinant FVIIa (rFVIIa) is a haemostatic agent approved for the treatment of haemophilia patients with inhibitors, patients with acqu...

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Published in:	Haemophilia : the official journal of the World Federation of Hemophilia Vol. 14; no. 1; pp. 103 - 110
Main Authors:	LAK, M., SCHARLING, B., BLEMINGS, A., SHARIFIAN, R., MALEKI, Z., DARAEE, A., ARJMAND, A. R., HEDNER, U.
Format:	Journal Article
Language:	English
Published:	Oxford, UK Blackwell Publishing Ltd 01-01-2008
Subjects:	Adolescent Adult Blood Coagulation - drug effects Blood Coagulation Tests Child Drug Monitoring - methods Factor VIIa - pharmacology Factor VIIa - therapeutic use Female Flow Cytometry Glanzmann thrombasthenia Hemostasis - drug effects Humans Male Recombinant Proteins - pharmacology Recombinant Proteins - therapeutic use rFVIIa ROTEM Thrombasthenia - blood Thrombasthenia - drug therapy Thrombelastography - standards thromboelastogram
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Summary:	Glanzmann thrombasthenia (GT) is a rare platelet function disorder characterized by a defect in fibrinogen binding to platelet membrane glycoprotein (GP) IIb/IIIa. Recombinant FVIIa (rFVIIa) is a haemostatic agent approved for the treatment of haemophilia patients with inhibitors, patients with acquired haemophilia and in EU also for treatment of factor VII (FVII)‐deficient patients and GT patients with antibodies to GPIIb‐IIIa. The present study was conducted to evaluate the use of the whole blood test system, rotational thrombelastometry (ROTEM), in measuring the overall haemostasis potential of rFVIIa in 28 GT patients treated with rFVIIa. The correlation of administered rFVIIa and time to start fibrin formation and clot dynamic/stability was assessed and correlation to the clinical response was elucidated. Assessments were performed on predose blood samples spiked with four different concentrations of rFVIIa and whole blood samples taken at 10 and 120 min following dosing. ROTEM parameters clotting time (CT), clot formation time (CFT) and maximum clot firmness (MCF) were measured. Both ex vivo and in vivo data showed beneficial effects on CT in the presence of rFVIIa, but no effect of added rFVIIa was seen on CFT and MCF. In conclusion, the use of thrombelastography at least in the modified form of ROTEM seems to be of limited use in predicting an adequate dose of rFVIIa in GT patients. A good clinical haemostatic response was recorded in spite of the limited changes in the ROTEM pattern supporting the conclusion that ROTEM should not be the method of choice for monitoring rFVIIa therapy in Glanzmann patients.
Bibliography:	istex:9E0E95F4209C2086026D661266044F9DDA7559C7 ark:/67375/WNG-W3G1SKS9-9 ArticleID:HAE1592 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1351-8216 1365-2516
DOI:	10.1111/j.1365-2516.2007.01592.x