1 Department of Pediatrics, Regional Comprehensive Hemophilia Diagnostic and Treatment Center, Cornell University Medical Center, New York
Achievement of hemostasis in patients with hemophilia who develop an inhibitor is known to be much more difficult than in the patient without an inhibitor although the frequency of bleeding is usually not increased. The introduction of prothrombin complex concentrates (PCC) and the activated prothrombin complex concentrates (APCC) containing an inhibitor bypassing activity afford a treatment modality that has been useful in some patients.1,2 However, clinical experience has shown that these concentrates are not as effective in patients with inhibitors as factor VIII concentrates are in patients without inhibitors. The lack of efficacy has resulted in escalation of dose and frequency of administration by physicians, particularly when using the currently available PCC.