The effects of emicizumab on in vitro coagulation and fibrinolysis parameters in patients with disseminated intravascular coagulation with and without addition of anti‐FVIII antibody

Abstract

AbstractBackgroundEmicizumab (Emi) is used as haemostatic prophylaxis for patients with haemophilia A (PwHA). Disseminated intravascular coagulation (DIC) is a condition characterized by persistent systemic activation of coagulation, but there is yet no information on coagulation and fibrinolysis potentials in Emi‐treated PwHA with DIC.AimTo examine the effect of Emi on coagulation and fibrinolysis potentials in HA‐model DIC plasmas.MethodsPlasma from a patient with sepsis‐DIC (seven patients) was treated with anti‐factor (F)VIII monoclonal antibody (HA‐model DIC plasma) and incubated with Emi (50 µg/mL). The plasma was then assessed using clot‐fibrinolysis waveform analysis (CFWA). Coagulation and fibrinolysis parameters were expressed as ratios relative to normal plasma (|min1|‐ratio and |FL‐min1|‐ratio, respectively).Patients and resultsIn case 1, coagulant potential was slightly high and fibrinolytic potential was extremely low, presenting a coagulant‐dominant state (|min1|‐ratio/|FL‐min1|‐ratio: 1.1/.38). In cases 2–5, fibrinolytic potential was not suppressed, but there were marked hypercoagulant potentials, indicating relative coagulant‐dominant states. In case 6, coagulant and fibrinolytic potentials were increased but well balanced (|min1|‐ratio/|FL‐min1|‐ratio: 1.38/1.28). In case 7, both potentials were severely deteriorated in not only CFWA but also the thrombin/plasmin generation assay. The addition of Emi into the HA‐model DIC plasmas increased |min1|‐ratio values in all cases, but the coagulant potentials did not exceed the initial ones (DIC plasma before treatment with anti‐FVIII antibody).ConclusionsThe presence of Emi in the HA‐model DIC plasma improved coagulation potentials, but did not increase coagulation potentials beyond those of DIC plasma in non‐HA states.