How is hypoprothrombinemia treated?

Updated: Jun 16, 2021
  • Author: J Nathan Hagstrom, MD; Chief Editor: Cameron K Tebbi, MD  more...
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Answer

Initial treatment of hypoprothrombinemia is aimed at controlling hemorrhage. Numerous products that provide prothrombin are available. Frozen plasma contains about 1 U/mL of prothrombin. It is readily available and contains other factors that may be useful if the hypoprothrombinemia is associated with multiple factor deficiencies. Concentrates of prothrombin complex (eg, Proplex T, Konyne 80, Bebulin VH, Kcentra, Beriplex P/N, ThromboPlex, Prothrombinex-HT) are concentrated sources of prothrombin. However, these products also contain other vitamin K–dependent factors in high concentration, and use of these products at high doses has been associated with thromboembolic complications. Prothrombin-complex concentrates may contain activated clotting factors, and their use has been associated with thromboembolic complications. No pure concentrate of prothrombin factor is available.

When lupus anticoagulant-hypoprothrombinemia syndrome (LAHS) is associated with systemic lupus erythematosus, treatment with steroids, intravenous immunoglobulin, fresh-frozen plasma, or azathioprine has been successful in reducing lupus anticoagulant levels, in increasing prothrombin levels, and in controlling bleeding. However, prothrombin levels have decreased in some patients when the drugs were tapered.

In vitamin K deficiency and warfarin overdose, vitamin K is the treatment of choice unless clinically significant bleeding is present and quick correction of the coagulopathy is desired. In these cases, use either frozen plasma or a prothrombin-complex concentrate.

The question of prophylactic treatment in patients with hypoprothrombinemia is controversial. No replacement protocols are standard. Prophylaxis has been reserved for patients who have had severe, recurrent episodes of bleeding. Case reports of patients with severe hypoprothrombinemia who were treated weekly with prothrombin-complex concentrates described a reduction in hemorrhagic episodes and improved quality of life.


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