antihemophilic factor

CV: chest tightness, hypotension, tachycardia

Derm: flushing, urticaria

EENT: visual disturbances

Hemat: intravascular hemolysis, postoperative hemorrhage

Neuro: headache, lethargy, loss of consciousness, paresthesia, sedation

Misc: jaundice, allergic reactions, chills, fever, hepatitis B, C, D, or HIV virus infection (small risk from frequent use of large amounts), rigor

Interactions ⬆ ⬇

Drug-drug:

None significant.

Availability ⬆ ⬇

Injection: 250 units/vial; 500 units/vial; 750 units/vial; 1000 units/vial; 1500 units/vial; 2000 units/vial; 3000 units/vial

Route/Dosage ⬆ ⬇

Recommended doses vary from product to product. Consult individual product information for more specific dosing information. Dose may be calculated using the following formula: Dose AHF (units) = body weight (kg) × desired AHF increase (% normal) × 0.5. Each unit of AHF/kg may be expected to produce a 2% rise in factor VIII activity

Prevention of Spontaneous Hemorrhage

IV (Adults and Children ): 25–40 AHF units/kg (or amount necessary to increase plasma factor VIII levels by 5–30% of normal, depending on situation).

Treatment of Minor Hemorrhage (severe epistaxis, oral mucosal bleeding)

IV (Adults and Children ): A single infusion of the amount necessary to increase plasma factor VIII levels by 20–30% (10–15 units/kg) every 8–12 hr for 1–2 days); additional antifibrinolytics needed for oral mucosal bleeding.

Treatment of Moderate Hemorrhage (hemarthroses/hematoma/GI bleeding/retroperitoneal bleeding)

IV (Adults and Children ): 15–25 units/kg (or amount necessary to increase plasma factor VIII levels by 30–50% ) every 8–12 hr for 1–2 days (continue for 1–2 days after GI bleeding stops or for at least 3 days following retroperitoneal hematoma).

Treatment of Trauma (without signs of bleeding/tongue or retropharyngeal bleeding)

IV (Adults and Children ): 20–25 units/kg (or amount needed to increase plasma factor VIII levels by 40–50%) every 8–12 hr for 2–4 days; additional antifibronlytics needed for tongue/retropharyngeal bleeding.

Treatment of Severe Hemorrhage (trauma with bleeding/intracranial bleeding)

IV (Adults and Children ): 50 units/kg (or amount needed to increase plasma factor VIII levels by 100% ) every 8–12 hr for 10–14 days (a continuous infusion of 3 units/kg/hr may also be used).

Management of Perioperative Hemostasis—Major Surgery

IV (Adults and Children ): 50 units/kg or amount necessary to raise plasma factor VIII levels to 100% of normal given then 50% of that amount every 8—12 hr to maintain level (a continuous infusion of 3 units/kg/hr may also be used) dosing may be tapered to maintain plasma factor VIII levels of at least 30% of normal for 10–14 days postoperatively; longer period may be required for orthopedic surgery.

Management of Perioperative Hemostasis—Dental or Oral surgery

IV (Adults and Children ): 40 units/kg; if antifibrinolytics are used, a single dose may be sufficient.

Treatment of von Willebrand's disease (Humate-P)

IV (Adults and Children ): 40–80 units/kg q 8–12 hr; further adjustments made on the basis of laboratory assessment and clinical situation.

Prevention of Postoperative Bleeding in Patients with von Willebrand's Disease

IV (Adults and Children ): 60 units/kg initially; then in 30 min with dose based on laboratory assessment and clinical situation. In emergency surgery a loading dose of 50–60 units/kg may be used with subsequent doses based on coagulation factor levels.

Prevention of Bleeding and Joint Damage in Children with Hemophilia A and No Pre-Existing Joint Damage (Kogenate FS and Helixate FS)

IV (Children ): 25 units/kg every other day.

Routine Prophylaxis (Advate, Novoeight, and Nuwiq)

IV (Adults and Children ): 20–40 units/kg every other day (3–4 times/week); adjust dose based on clinical response.

US Brand Names ⬆ ⬇

Advate, AHF, Alphanate, Bioclate, factor VIII, Helixate FS, Helixate NexGen, Humate-P, Koate-DVI, Kogenate, Kogenate FS, Monoclate-P, Novoeight, Nuwiq, Recombinate, Xyntha

Action ⬆ ⬇

An essential clotting factor required for the conversion of prothrombin to thrombin.

Therapeutic effects:

Correction of deficiency states with resultant decreased bleeding.

Classifications ⬆ ⬇

Therapeutic Classification: hemostatic agents

Pharmacologic Classification: blood products

Pharmacokinetics ⬆ ⬇

Absorption: After IV administration, absorption is complete.

Distribution: Rapidly cleared from plasma; does not cross the placenta.

Metabolism/Excretion: Used up in the clotting process.

Half-Life: 8.4–19.3 hr (reduced in the presence of inhibitor antibodies and during active bleeding).

Time/Action Profile ⬆ ⬇

(levels of factor VIII)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	1–2 hr	8–12 hr

Patient/Family Teaching ⬆ ⬇

Instruct patient to notify health care professional immediately if bleeding recurs. Advise patient to observe for bleeding in gums, skin, urine, stool, or emesis.
Inform patient inhibitor formation may occur with treatment of hemophilia A. Advise patient to contact their health care professional if they experience lack of clinical response to Factor VIII replacement therapy; may be due to an inhibitor.
Caution patient to avoid products containing aspirin or NSAIDs; they may further impair clotting.
Review prevention of bleeding with patient (use soft toothbrush, avoid IM and SUBQ injections, avoid potentially traumatic activities).
Inform newly diagnosed hemophilia patients of the need for hepatitis B vaccine. Advise patient that the risk of hepatitis or AIDS transmission may be diminished by the use of heat-treated, pasteurized, solvent/detergent-treated, or monoclonal antibody preparations. Screening programs should also decrease risk.
Advise patients to consult health care professional prior to travel. While traveling advise patients to bring an adequate supply of AHF based on their current treatment regimen.
Advise patient to carry identification describing disease process at all times.

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Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇