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Semin Thromb Hemost 2000; Volume 26(Number 4): 0373-0378
DOI: 10.1055/s-2000-8455
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel. +1(212)584-4662.

The Factor VII-Platelet Interplay: Effectiveness of Recombinant Factor VIIa in the Treatment of Bleeding in Severe Thrombocytopathia

Dougald M. Monroe, Maureane Hoffman, Geoffrey A. Allen, Harold R. Roberts
  • Center for Thrombosis and Hemostasis (HRR) and Hematology/Oncology, UNC School of Medicine (DMM), Chapel Hill, North Carolina and Durham VA Medical Center (MH, GAA), Duke University Medical Center, Durham, North Carolina
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Publication History

Publication Date:
31 December 2000 (online)

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ABSTRACT

-Recently, high-dose factor VIIa has been used to correct bleeding in patients with various thrombocytopathias including Glanzmann's thrombasthenia, Bernard-Soulier syndrome, and uremia. High-dose factor VIIa is postulated to act on platelets in the absence of tissue factor to activate factors IX and X and thus enhance thrombin generation. This enhanced thrombin generation might help provide hemostasis in patients with thrombocytopathias through several mechanisms. Enhanced thrombin generation would provide a strong signal for recruitment of other platelets. Also, enhanced fibrin deposition might provide mechanisms for bypassing the specific defect in thrombocytopathias. Thus, platelets from a patient with Bernard-Soulier syndrome might associate with fibrin by a glycoprotein IIb-IIIa-mediated mechanism. Also, platelets from a patient with Glanzmann's thrombasthenia might associate with fibrin through von Willebrand factor-mediated interactions with glycoprotein Ib-V-IX. Finally, enhanced thrombin generation on platelets would mean that fewer platelets are required for hemostasis.

KEYWORD

Factor VIIa - thrombin generation - thrombocytopathia - Bernard-Soulier syndrome - Glanzmann's thrombasthenia

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