Hypoprothrombinemia Medication

  • Author: J Nathan Hagstrom, MD; Chief Editor: Robert J Arceci, MD, PhD   more...
 
Updated: Feb 29, 2012
 

Medication Summary

The treatment of hypoprothrombinemia depends on the underlying etiology. Numerous products that provide prothrombin are available.

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Hemostatic agents

Class Summary

Vitamin K can be administered intravenously or orally. Slowly administer intravenous infusions over 10-20 minutes. In addition, premedicating the patient with diphenhydramine (Benadryl) may be helpful. The only current oral formulation of vitamin K available in the United States is in tablet form; however, a liquid formulation has been developed and is currently being used in Europe and Japan.

Acquired hypoprothrombinemia due to vitamin K deficiency is treated with vitamin K1 (phytonadione). In the presence of severe or life-threatening bleeding, frozen plasma or prothrombin-complex concentrates are administered to immediately increase the levels of vitamin K–dependent coagulation factors. Other clotting factors (eg, concentrate of clotting factors II, VII, IX, and X [Proplex T]) may also be required. Solvent-detergent–treated frozen plasma is now available.

Epsilon aminocaproic acid (Amicar) can be used to minimize the severity of mucosal bleeding and enhances hemostasis when fibrinolysis contributes to bleeding. Amicar is especially useful in acquired hypoprothrombinemia secondary to anti–factor II circulating antibodies because of the immediate neutralization of prothrombin upon infusing plasma or prothrombin-complex concentrates.

For inherited hypoprothrombinemia, concentrates of prothrombin complex (eg, Autoplex T) are used. No recombinant factor II product is available.

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Aminocaproic acid (Amicar)

 

A 6-aminohexanoic acid that inhibits fibrinolysis by inhibiting plasminogen activator substances and, to some degree, antiplasmin activity.

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Anti-inhibitor coagulant complex (Feiba VH Immuno)

 

Prothrombin-complex concentrates contain vitamin K–dependent clotting factors. Prepared from pooled normal human plasma. Some products contain more activated factors than others. Presence of activated factors increases risk of thromboembolic complications.

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Phytonadione (AquaMEPHYTON, Mephyton)

 

Promotes liver synthesis of clotting factors. Aqueous colloidal solution of vitamin K1 for parenteral injection. This form has same activity as naturally occurring vitamin K. Vitamin K is essential cofactor for microsomal enzyme that catalyzes posttranslational carboxylation of several specific peptide-bound glutamic acid residues in inactive hepatic precursors of vitamin K–dependent factors. Results in gamma-carboxyglutamic acid residues necessary for calcium-dependent phospholipid membrane binding.

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Fresh frozen plasma

 

Plasma is fluid compartment of blood that contains soluble clotting factors. For use in patients with deficiencies of blood products. Indications include bleeding in patients with congenital coagulation defects and deficiencies of multiple coagulation factors (severe liver disease).

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Contributor Information and Disclosures
Author

J Nathan Hagstrom, MD  Division Head and Director, Hematology-Oncology, Connecticut Children's Medical Center; Associate Professor of Pediatrics, University of Connecticut

J Nathan Hagstrom, MD is a member of the following medical societies: American Society of Hematology, American Society of Pediatric Hematology/Oncology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Coauthor(s)

James L Harper, MD  Associate Professor, Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplantation, Associate Chairman for Education, Department of Pediatrics, University of Nebraska Medical Center; Assistant Clinical Professor, Department of Pediatrics, Creighton University School of Medicine; Director, Continuing Medical Education, Children's Memorial Hospital; Pediatric Director, Nebraska Regional Hemophilia Treatment Center

James L Harper, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Federation for Clinical Research, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Council on Medical Student Education in Pediatrics, and Hemophilia and Thrombosis Research Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Gary R Jones, MD  Associate Medical Director, Clinical Development, Berlex Laboratories

Gary R Jones, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Pediatric Hematology/Oncology, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Gary D Crouch, MD  Associate Professor, Program Director of Pediatric Hematology-Oncology Fellowship, Department of Pediatrics, Uniformed Services University of the Health Sciences

Gary D Crouch, MD is a member of the following medical societies: American Academy of Pediatrics and American Society of Hematology

Disclosure: Nothing to disclose.

Samuel Gross, MD  Professor Emeritus, Department of Pediatrics, University of Florida; Clinical Professor, Department of Pediatrics, University of North Carolina; Adjunct Professor, Department of Pediatrics, Duke University

Samuel Gross, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, American Society of Hematology, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Robert J Arceci, MD, PhD  King Fahd Professor of Pediatric Oncology, Professor of Pediatrics, Oncology and the Cellular and Molecular Medicine Graduate Program, Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine

Robert J Arceci, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Pediatric Society, American Society of Hematology, and American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor Sara E Tisdale, MD, to the development and writing of this article.

References

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