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To the Editor.—
The recent article by DeWitt and Feinstein (Archives 137:1211-1213, 1977) documents the efficacy of prothrombin complex concentrate (Konyne) in stopping the bleeding in a hemophilic patient with a high-titer antifactor VIII antibody. This favorable response of patients with hemophilia and factor VIII inhibitors to prothrombin complex concentrates has been observed by many physicians who care for a large hemophilic population.However, the conclusions reached by the authors that "there is now convincing evidence that prothrombin complex concentrates are the treatment of choice in patients with factor VIII inhibitors with uncontrollable bleeding," should be challenged for several reasons: (1) There have clearly been failures in patients when prothrombin complex concentrates were employed. (2) There appears to be significant lot-to-lot variability in the effectiveness of the products in controlling bleeding. Many investigators believe that currently available concentrates are less effective than they were two to four years ago. Therefore,
Blatt PM, Goldsmith JC, Roberts HR. Prothrombin Complex Concentrates. Arch Intern Med. 1978;138(5):827. doi:10.1001/archinte.1978.03630290107045