Medication Summary
The treatment of hypoprothrombinemia depends on the underlying etiology. Numerous products that provide prothrombin are available.
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.
Aminocaproic acid (Amicar)
A 6-aminohexanoic acid that inhibits fibrinolysis by inhibiting plasminogen activator substances and, to some degree, antiplasmin activity.
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.
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.
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).
