Treatment should begin under the strict supervision of a doctor who has experience in the therapy of hemophilia.
Doses and duration of substitution therapy depends on the severity of the deficiency of the coagulation factor VIII, the localization and volume of bleeding, and the severity of the clinical condition of the patient.
Calculation of the required dose of coagulation factor VIII (FVIII) is based on empirical data: 1 IU FVIII / kg of body weight increases the activity of the clotting factor in plasma by 1.5-2%.
Given the initial activity of the coagulation factor VIII in the patient's plasma, the calculation of the required dose of the drug is carried out according to the formula:
The required dose (ME FVIII) = body weight of the patient (kg) x required increase in activity FVIII (%) x 0.5.
The total dose and frequency of drug administration should always be correlated with clinical efficacy in each case.
The following table reflects the level of FVIII required to stop bleeding or prevent bleeding during surgical interventions, as well as the duration of maintenance of the necessary activity of FVIII in the blood plasma of the patient.
| Severity of bleeding / volume of surgical intervention | Required level of fVIII in blood plasma (% from the norm) | Multiplicity of administration / duration of therapy |
| Minor bleeding Hemorrhages in the joints | 30 | At least 1 day, until the bleeding stops |
| Significant bleeding | 40-50 | Repeat infusions every 12-24 hours for 3-4 days or more until the bleeding stops completely, the wound is healed, or the pain stops and the joint movements recovered. |
| Pronounced hemarthrosis, muscle hemorrhage, tooth extraction, slight head injury, mild surgical interventions, bleeding from the oral cavity |
| Life-threatening bleeding Severe surgery, gastrointestinal bleeding, intra-abdominal, intracranial or pleural bleeding, fractures | 60-100 | Within 7 days, then maintenance therapy for the next 7 days (activity FVIII 30-60%) |
In some cases, more than calculated amounts of the drug may be needed, especially at the start of therapy.
During the course of treatment it is recommended to determine the activity of FVIII for correcting the dose of the drug and the frequency of its administration. In the case of extensive surgical interventions, accurate monitoring of substitution therapy is particularly needed, which implies the determination of the activity of FVIII in blood plasma.Patients may have a different response to the administration of FVIII, giving different levels in vivo release of the factor and its half-life.
Patients should be checked for the appearance of inhibitors of FVIII. If the expected increase in the activity of the factor in the blood plasma is not achieved, or the bleeding is not controlled by the appropriate dose, then it is necessary to conduct a test for the presence of inhibitors of vWIII activity. If the inhibitor is present in an amount of less than 10BE (BetaZedEnits) in ml, the administration of an additional amount of the human coagulation factor VIII can neutralize the inhibitor. Patients with an inhibitor level of more than 10 BY or a high history of an anesthetic are recommended to administer a concentrate of the prothrombin complex.
In patients with von Willebrand's disease, substitution therapy is carried out empirically and depends on the level of fVIII in the blood plasma, which is measured daily (before and after the administration of the drug EHIKLOT DI). Monitoring of bleeding time is mandatory in cases of bleeding from mucous and non-stop, despite adequate level VIII: C in blood plasma. In these patients, the dose of EMOKLOT D.I. it is necessary to increase.
Cooking method
EMOKLOT D.I.must be dissolved immediately before administration. Do not use the solution in the presence of flaky and other mechanical inclusions in it. The drug is administered intravenously for 3-5 minutes under the control of the patient's pulse.
Add the solvent to the lyophilized substance through a double needle and rotate the vial with the concentrate until completely dissolved. The lyophilized substance can be dissolved more quickly if the solvent is heated in a water bath to a temperature of no higher than 37 ° C. With incomplete dissolution of the drug, it will be difficult to filter through the filter needle. To avoid foaming, the solvent must be slowly poured onto the wall of the vial with the lyophilized preparation. After the preparation of the solution, it must be dialed into the syringe using a filter needle, after which the needle is changed and, using the injection equipment from the supplied kit, enter the drug intravenously at the indicated rate.