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Continuous infusion of coagulation factors

Authors


Professsor Uri Martinowitz, The National Hemophilia Center, Chaim Sheba Medical Center, Tel.: Hashomer 52621, Israel. Tel.: + 1 972 3 5302120/2411; fax: + 1 972 3-5351806; e-mail: martinur@bezeqint.net

Abstract

Summary.  Continuous infusion (CI) of coagulation factor concentrate is aimed at maintaining a steady haemostatic level of the missing factor in circulation, preventing dangerous troughs below the haemostatic level and unnecessary high peaks, which increase the safety and decrease the consumption of factor concentrate replacement therapy. This can be achieved by the administration of the coagulation factor at a rate corresponding to its elimination. CI has been used in wider extent since the early 1990s, after the resolution of basic questions such as the stability of factor concentrates after reconstitution, the risk of contamination and bacterial overgrowth in these biological materials during either preparation of infusion bags or prolonged administration, the frequent local thrombophlebitis, the knowledge of pharmacokinetics of coagulation factors in the conditions of CI and the developement of adequate minipumps. The increasing clinical experience with CI used in haemophilia A and B and von Willebrand disease has proven the advantages of this mode of replacement therapy, providing improved margins of efficacy and safety in various clinical settings requiring the maintenance of haemostatic levels over prolonged periods, as well as reduction in treatment cost compared with the traditional therapy via intermittent injections of coagulation factors.Keywords: continuous infusion, factor VIII, factor IX, haemophilia, recombinant FVIIIa, von willebrand disease.

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