Longo G, Messori A, Morfini M, Baudo F, Ciavarella N, Cinotti S, Filimberti E, Giustarini G, Molinari A C, Ferrini P R
Centro Emofilici e Università di Firenze, Italy.
Am J Hematol. 1989 Mar;30(3):140-9. doi: 10.1002/ajh.2830300305.
The pharmacokinetics of factor VIII were studied in a series of 20 hemophilia-A patients undergoing surgery. Regardless of the type of operation, elimination of factor VIII was shown to be increased only in ten cases (50%) during the post-operative period. In this subgroup of patients, factor VIII half-life, measured immediately after surgery, was considerably shorter (mean = 9.6 hr, n = 10) than that determined in the same individual during the late operative period (mean = 17.8 hr, n = 10). These findings indicate that identification of patients with increased postoperative consumption of factor VIII can be of value in reducing the risk of hemorrhage in these subjects and in exposing other subjects with no postoperative increase in factor VIII clearance to less of the deficient factor. Data from 20 subjects were analyzed to construct a nomogram allowing individualized prediction of factor VIII dosing requirements. The nomogram, which is based on the "single point after a single dose" method, uses a value of factor VIII concentration measured at 10 hr after preoperative loading dose to predict the regimen producing the desired average steady-state concentration of factor VIII (30, 60, or 90 units/dl).
在一组20例接受手术的甲型血友病患者中研究了凝血因子VIII的药代动力学。无论手术类型如何，术后仅10例（50%）患者的凝血因子VIII清除率增加。在该亚组患者中，术后立即测得的凝血因子VIII半衰期（平均=9.6小时，n=10）明显短于同一患者在手术后期测得的半衰期（平均=17.8小时，n=10）。这些发现表明，识别术后凝血因子VIII消耗增加的患者对于降低这些患者的出血风险以及使其他术后凝血因子VIII清除率未增加的患者接触较少的缺乏因子具有重要价值。分析了20名受试者的数据以构建一个列线图，用于个体化预测凝血因子VIII的给药需求。该列线图基于“单次给药后单点”方法，使用术前负荷剂量后10小时测得的凝血因子VIII浓度值来预测产生所需凝血因子VIII平均稳态浓度（30、60或90单位/分升）的给药方案。
