This is a very interesting article which casts new light on the mechanism of hemostasis of rFVIIa in hemophiliac patients with inhibitors to factor VIII. rFVIIa is known to exert its hemostatic effect by binding with tissue factor and activation of factors IX, X and XI, and formation of thrombin burst. This study shows that there is a possible additional mechanism which is down-regulation of fibrinolysis by combining with thrombin activatable fibrinolysis inhibitor (TAFI). This process is also dependent on tissue factor, as well as thrombomodulin.

– M. Aldouri.