Summary
The haemostatic effectiveness of activated FVIII was compared to that of non-activated FVIII in a cross-over study in a canine model of haemophilia. Activation of FVIII in porcine concentrate was achieved by the addition of 3 × 10−5 IU thrombin per ml of concentrate, which gave consistent increases in 1-stage FVIII activity of 13- to 14-fold and slow decay. The haemostatic effect was monitored by measurements of the cuticle bleeding time 10 and 45 min after infusion and there were no consistent differences between the activated and non-activated concentrates. One-stage factor VIII assays on plasmas 5 min after infusion showed identical mean values for activated and non-activated concentrates, indicating that most of the higher activity observed in vitro had disappeared rapidly from the circulation.
These results suggest that controlled activation of FVIII by thrombin, which increases its activity in 1-stage assays, is unlikely to be of therapeutic benefit. For therapeutic concentrates which may contain small amounts of activated FVIII, the 1-stage assay may be an unreliable guide to their therapeutic effect.
