eMedicine Specialties > Hematology > Coagulation, Hemostasis, and Disorders

Factor II: Treatment & Medication

Author: Christopher J Steen, MD, Staff Physician, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Coauthor(s): Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School; Pere Gascon, MD, PhD, Professor and Director, Division of Medical Oncology, Institute of Hematology and Medical Oncology, IDIBAPS, University of Barcelona Faculty of Medicine, Spain
Contributor Information and Disclosures

Updated: Dec 2, 2008

Treatment

Medical Care

Treatment of factor II deficiency should be individualized and aimed at restoring circulating factor II to levels sufficient for hemostasis. Levels greater than 30% of normal are usually adequate. Additionally, in patients with acquired factor II deficiency, the underlying cause should be found and treated.

  • Infusion of fresh frozen plasma (FFP) is usually sufficient to treat most cases of bleeding. A loading intravenous (IV) dose of 15-20 mL/kg is administered, followed by a maintenance dose of 3-6 mL/kg IV q12-24h.
  • Plasma exchange transfusion may be used to increase factor II levels before surgery.
  • Prothrombin complex concentrates (PCCs) have also been used to increase factor II levels.35 PCCs contain factors II, VII, IX, and X, along with protein C. PCCs should be used judiciously because of the risk of thromboembolic complications.
  • Vitamin K administration may be useful in patients with acquired factor II deficiency.

Consultations

  • Hematologists
  • Genetic counselors (in patients with congenital factor II deficiency)

Diet

No dietary restrictions are necessary in individuals with factor II deficiency. Patients should be advised to decrease consumption of alcohol to reduce the risk of alcohol-induced liver disease.

Activity

Activity should be regulated based on the severity of the factor II deficiency and the presence or absence of symptoms. Because of the risk of hemorrhage following traumatic injury, activities with high levels of physical contact are not recommended.

Medication

The goals of pharmacotherapy in those with factor II deficiency are to reduce morbidity and to prevent complications.

Blood Products

Blood products are indicated for the correction of abnormal hemostatic parameters.


Fresh frozen plasma

Plasma is the fluid compartment of blood that contains the soluble clotting factors. Indications for using FFP include bleeding in patients with congenital coagulation defects and multiple coagulation factor deficiencies (severe liver disease).

Adult

Loading dose: 15-20 mL/kg IV

Maintenance dose: 3-6 mL/kg IV q12-24h (half-life of factor II is ~3 d)

Pediatric

Administer as in adults.

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

Precautions

Viral contamination and infection are possible, but they are unlikely because of prescreening; may induce an anamnestic response


Prothrombin complex concentrates

Product made from pooled human plasma. Prothrombin complex concentrates contain factors II, VII, IX, X; protein C; and trace amounts of heparin to guard against thrombosis. Currently recommended for patients with coagulation factor inhibitors only.

Adult

Dosages must be clinically determined and are case dependent; the typical dosage is 50-125 U/kg; because of the risk of thrombotic complications, no more than 3 standard doses should be administered in the first 36-48 h

Pediatric

Administer as in adults.

When administered simultaneously with recombinant FVIIa, may lead to thrombotic complications; should not be used in combination with antifibrinolytics, as this combination may increase the risk of thrombosis

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Monitor for thrombotic complications and hypersensitivity reactions; clinical response, PT, and aPTT should be closely monitored throughout the therapy; if there is no clinical response to the therapy with prothrombin complex concentrates, another treatment should be considered.

Vitamins, Fat-Soluble

Fat-soluble vitamins may play essential role in the function of clotting factors.


Phytonadione (AquaMEPHYTON)

Fat-soluble vitamin K absorbed by the gut and stored in the liver. Necessary for the function of clotting factors in the coagulation cascade. Used to replace essential vitamins that are not obtained in sufficient quantities in the diet or to further supplement levels.

Adult

10 mg PO/IV/IM/SC to replete liver stores

Pediatric

1 mg IM as single dose

Antagonizes the effects of warfarin, sodium, and dicumarol

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Ineffective in hereditary hypoprothrombinemia; rapid infusion may result in flushing and a feeling of constriction in the chest; relatively nontoxic, even in massive doses

More on Factor II

Overview: Factor II
Differential Diagnoses & Workup: Factor II
Treatment & Medication: Factor II
Follow-up: Factor II
References
Further Reading
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References

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Keywords

factor II, acquired factor II deficiency, inherited factor II deficiency, deficiency of factor II, prothrombin deficiency, hypoprothrombinemia, FII, F II, prothrombin, vitamin K–dependent proenzyme, vitamin K deficiency, prothrombin abnormality, clotting, coagulation, coagulation disorder, blood coagulation cascade, dysprothrombinemia, prothrombin complex concentrates, prothrombin 20210a, thrombophilia

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Contributor Information and Disclosures

Author

Christopher J Steen, MD, Staff Physician, Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Christopher J Steen, MD is a member of the following medical societies: Alpha Omega Alpha and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Pere Gascon, MD, PhD, Professor and Director, Division of Medical Oncology, Institute of Hematology and Medical Oncology, IDIBAPS, University of Barcelona Faculty of Medicine, Spain
Pere Gascon, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, New York Academy of Medicine, New York Academy of Sciences, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Paul Schick, MD, Emeritus Professor, Department of Internal Medicine, Thomas Jefferson University Medical College; Research Professor, Department of Internal Medicine, Drexel University College of Medicine; Adjunct Professor of Medicine, Lankenau Hospital, Wynnewood, PA
Paul Schick, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Hematology, International Society on Thrombosis and Haemostasis, and New York Academy of Sciences
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ronald A Sacher, MB, BCh, MD, FRCPC, Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center
Ronald A Sacher, MB, BCh, MD, FRCPC is a member of the following medical societies: American Society of Hematology
Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

CME Editor

Rebecca J Schmidt, DO, FACP, FASN, Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine
Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association
Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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