Fatal Myocardial Necrosis Associated with Prothrombin-Complex–Concentrate Therapy in Hemophilia A

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Abstract
To the Editor: In August 1979 we observed fatal myocardial necrosis in a 17-year-old boy with hemophilia A and a circulating anticoagulant (370 Bethesda units per milliliter of plasma) who received large amounts of prothrombin-complex concentrate. Nonfatal myocardial infarcts have occurred in at least two other hemophiliacs with circulating anticoagulants during treatment with large doses of similar concentrates.1 , 2 We then examined the original Konȳne preparation that had been used to treat this patient, which was stored at -70°C, and its contents suggested a possible pathophysiologic mechanism of the lesion.Before his death, the patient received 168 vials (500 U per . . .