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Factor XIII

Class: Hemostatics
VA Class: BL500
Chemical Name: Human Factor XIII [A2] homodimer (allele F13A*1B)
Molecular Formula: C3708H5735N1013O1111S28
CAS Number: 606138-08-3
Brands: Corifact

Medically reviewed by Drugs.com on Feb 17, 2022. Written by ASHP.

Introduction

Preparation of blood coagulation factor XIII derived from pooled human plasma.

Uses for Factor XIII

Congenital Factor XIII Deficiency

Routine prophylaxis and perioperative management of bleeding in patients with congenital factor XIII deficiency; designated an orphan drug by FDA for treatment of congenital factor XIII deficiency.

Initial FDA-labeled use based on trough factor XIII levels (5–20%) as a surrogate measure of efficacy; clinical benefit (i.e., prevention of bleeding episodes) established in a postmarketing study.

Prophylactic therapy with factor XIII concentrates is recommended in all patients with severe (<1% factor XIII activity) deficiency; considered current standard of care.

Currently available factor XIII concentrates in the US include a plasma-derived (Corifact) and a recombinant (Tretten) preparation. Some experts recommend preferential use of recombinant preparations because of their potentially superior safety profile with respect to pathogen transmission. (See Risk of Transmissible Agents in Plasma-derived Preparations under Cautions.) When selecting an appropriate factor XIII preparation, consider characteristics of each clotting factor concentrate in addition to individual patient variables.

Acquired Factor XIII Deficiency

Has been used to treat acquired factor XIII deficiency associated with various diseases or other conditions.

Factor XIII Dosage and Administration

Administration

IV Administration

Administer by slow IV injection. (See Rate of Administration under Dosage and Administration.)

Reconstitution

Reconstitute lyophilized powder with manufacturer-supplied sterile water for injection diluent. Prior to reconstitution, allow drug and diluent to warm to room temperature. Gently swirl vial; do not shake.

Use reconstituted solution promptly, or no more than 4 hours after reconstitution. Discard unused portion.

Rate of Administration

Administer at a rate not exceeding 4 mL/minute.

Dosage

Dosage expressed in international units (IU, units) of factor XIII activity. Each vial contains 1000–1600 units of factor XIII (human); actual number of units indicated on each vial and carton.

Individualize dosage based on factor XIII levels, presence and severity of bleeding, and clinical response. (See Laboratory Monitoring under Cautions.)

Initial dose of 40 units/kg recommended; adjust subsequent dose in increments or decrements of 5 units/kg based on trough factor XIII activity levels. (See Table 1.)

Table 1. Dose Adjustment Using the Berichrom Activity Assay

Trough Factor XIII Activity

Dose Change

One trough level of <5%

Increase by 5 units/kg

Trough level of 5–20%

No change

Two trough levels of >20%

Decrease by 5 units/kg

One trough level of >25%

Decrease by 5 units/kg

Pediatric Patients

Congenital Factor XIII Deficiency

Dosage adjustment in pediatric patients <16 years of age may be required due to age-related differences in pharmacokinetics. (See Special Populations under Pharmacokinetics.)

Routine Prophylaxis of Bleeding
IV

40 units/kg every 28 days. Adjust dosage to maintain factor XIII levels of 5–20%. (See Table 1.)

Perioperative Management of Bleeding
IV

Additional dosing may be necessary in patients undergoing surgery depending on the timing of their last prophylactic dose. Individualize dosing requirements based on type of surgery, factor XIII activity, and clinical response.

If last prophylactic dose given within 7 days of surgery, additional dose generally not needed.

If last prophylactic dose given 8–21 days previously, an additional partial or full dose is recommended depending on factor XIII levels.

If last prophylactic dose was given 21–28 days previously, an additional full dose is recommended.

Adults

Congenital Factor XIII Deficiency
Routine Prophylaxis of Bleeding
IV

40 units/kg every 28 days. Adjust dosage to maintain factor XIII levels of 5–20%. (See Table 1.)

Perioperative Management of Bleeding
IV

Additional dosing may be necessary in patients undergoing surgery depending on the timing of their last prophylactic dose. Individualize dosing requirements based on type of surgery, factor XIII activity, and clinical response.

If last prophylactic dose given within 7 days of surgery, additional dose generally not needed.

If last prophylactic dose given 8–21 days previously, an additional partial or full dose is recommended depending on factor XIII levels.

If last prophylactic dose was given 21–28 days previously, an additional full dose is recommended.

Special Populations

Pregnant Women

Achievement of plasma factor XIII activity levels of at least 2–3% (ideally >10%) during early gestation and >30% during labor suggested. Timing and optimum dosage for maintenance of successful pregnancy not fully elucidated.

Cautions for Factor XIII

Contraindications

  • Known anaphylactic or severe systemic reactions to human plasma-derived products.

Warnings/Precautions

Sensitivity Reactions

Hypersensitivity Reactions

Hypersensitivity reactions (e.g., allergy, rash, pruritus, erythema) observed.

Discontinue administration immediately and institute appropriate treatment if manifestations of anaphylaxis or hypersensitivity reactions (e.g., urticaria, rash, chest tightness, wheezing, hypotension) occur.

Immunogenicity

Although frequency low, inhibitory antibodies against factor XIII detected in patients receiving factor XIII (human). Presence of inhibitory antibodies may manifest as inadequate response to treatment.

Monitor patients for possible development of inhibitory antibodies. If expected plasma factor XIII activity levels not attained or breakthrough bleeding occurs during prophylaxis, measure factor XIII inhibitory antibody concentrations.

Thromboembolic Complications

Thromboembolic complications reported. Closely monitor patients with known risk factors.

Risk of Transmissible Agents in Plasma-derived Preparations

Factor XIII (human) is prepared from human blood and may carry risk of transmitting infectious agents (e.g., viruses and, theoretically, the Creutzfeldt-Jakob disease [CJD] agent). Also potentially capable of transmitting unknown infectious agents.

Report any suspected infections associated with factor XIII (human) to CSL Behring Pharmacovigilance Department at 866-915-6958 or FDA at 800-FDA-1088 or [Web].

Laboratory Monitoring

Monitor patient’s trough factor XIII activity level during treatment. Also monitor during and after surgery.

If breakthrough bleeding occurs or expected peak plasma factor XIII activity levels not attained, perform investigation to determine presence of factor XIII inhibitory antibodies.

Specific Populations

Pregnancy

Category C.

Safety and efficacy during labor and delivery not established; however, has been used throughout pregnancy in some women with congenital factor XIII deficiency to prevent spontaneous abortion and obstetrical hemorrhagic complications.

Lactation

Not known whether factor XIII (human) is distributed into human milk. Use caution.

Pediatric Use

Has been used in some children <2 years up to 16 years of age.

No apparent differences in safety profile in children compared with adults. However, differences in pharmacokinetic profile observed; dosage adjustments may be necessary in patients <16 years of age. (See Special Populations under Pharmacokinetics.)

Geriatric Use

Safety and efficacy in geriatric patients not established.

Common Adverse Effects

Hypersensitivity reactions (i.e., rash, pruritus, erythema), joint inflammation, hematoma, arthralgia, headache, elevated thrombin-antithrombin levels, increased blood LDH.

Interactions for Factor XIII

No formal drug interaction studies to date.

Factor XIII Pharmacokinetics

Absorption

Duration

IV dose results in increased plasma factor XIII activity levels for approximately 28 days.

Plasma Concentrations

Mean increase (from baseline) in plasma factor XIII activity levels after third dose (steady state) given every 28 days: 83% (range: 48–114%).

Elimination

Half-life

5–12 days (mean: 6.6 days).

Special Populations

Patients <16 years: Possible shorter half-life and faster clearance than in adults.

Stability

Storage

Parenteral

Powder for Injection

2–8°C; avoid freezing. Store in original carton and protect from light.

Stable for 24 months at 2–8°C, up to the expiration date on carton and vial label.

May store at room temperature (≤25°C) for up to 6 months. Do not use beyond the expiration date on carton and vial labels or beyond the period of room temperature storage, whichever comes first.

Do not return product to refrigerator after storage at room temperature.

Reconstituted solutions: Use within 4 hours after reconstitution. Do not refrigerate or freeze.

Actions

  • Preparation of blood coagulation factor XIII derived from pooled human plasma.

  • Congenital factor XIII deficiency is a rare but serious bleeding disorder manifested by a lifelong bleeding tendency that typically includes umbilical bleeding during the neonatal period, delayed soft tissue bruising, mucosal bleeding, poor wound healing, recurrent miscarriage, and intracranial hemorrhage.

  • Factor XIII circulates in plasma as a heterotetrameric glycoprotein consisting of 2 A-subunits and 2 B-subunits. Enzymatic activity resides in the A-subunit; B-subunits function as carrier molecules for the A-subunits.

  • Factor XIII is a proenzyme that is activated in the presence of calcium by thrombin cleavage of the A-subunit to become activated factor XIII (factor XIIIa).

  • Factor XIIIa promotes cross-linking of fibrin and other proteins, resulting in a fibrin clot that is more elastic and resistant to fibrinolysis.

  • Factor XIIIa also cross-links α2-plasmin inhibitor to the α-chain of fibrin, resulting in protection of the fibrin clot from degradation by plasmin.

Advice to Patients

  • Possible risk of transmission of infectious agents (e.g., viruses, and theoretically, the CJD agent).

  • Importance of reporting signs and symptoms of hypersensitivity reactions (e.g., urticaria, rash, tightness of the chest, wheezing, hypotension, anaphylaxis) experienced during or after injection of factor XIII (human).

  • Importance of informing patients of the signs and symptoms of immunogenicity (e.g., breakthrough bleeding).

  • Importance of informing patients of signs and symptoms of thrombosis (e.g., swelling of limb or abdomen and/or pain; chest pain; shortness of breath; loss of sensation or motor power; altered consciousness, vision, or speech).

  • Importance of women informing clinician if they are or plan to become pregnant or plan to breast-feed.

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.

  • Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

Factor XIII (Human)

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

For injection, for IV use only

number of units indicated on label

Corifact (with sterile water for injection diluent; available with alcohol swab and filter transfer set)

CSL Behring

AHFS DI Essentials™. © Copyright 2022, Selected Revisions February 27, 2017. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

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