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Can we Boost Emicizumab Without Increasing Thrombosis Risk? – RPTH Journal
RPTH Journal
Feb 14, 2026, 16:56

Can we Boost Emicizumab Without Increasing Thrombosis Risk? – RPTH Journal

RPTH Journal shared a post on LinkedIn:

”Can we boost emicizumab without increasing thrombosis risk?

Emicizumab transformed hemophilia A care.

But breakthrough bleeding still happens, and treatment options remain imperfect.

A new RPTH study explores a provocative idea:

What if adding low-dose FIX plus FX together could safely enhance emicizumab-driven coagulation?

Here’s the key signal:
Combined FIX/FX supplementation restored coagulation potential to near-normal levels in vitro, in patient samples, and in hemophilia A mice.

Why this is biologically plausible:

  • Emicizumab works by bridging FIXa and FX
  • More FIX + FX to more ternary complex formation
  • ~2× increase in FIX–emicizumab–FX complexes predicted
  • Faster clot formation and reduced bleeding in vivo
  • Thrombotic markers did not increase in animal models

Translation:
Rather than pushing bypassing agents harder, we may be able to optimize the emicizumab pathway itself.

Big questions for clinicians and researchers:

  • Could FIX+FX become an alternative to rFVIIa for breakthrough bleeds?
  • Could this strategy reduce treatment burden and dosing frequency?
  • How do we balance enhanced hemostasis with real-world thrombosis risk?”

Title: Augmented emicizumab-driven coagulation potential in hemophilia A state by in vitro and in vivo supplementation of combined factors IX and X

Authors: Mitsumasa Osuna, Yuto Nakajima, Eisuke Takami, Hirotoshi Nakano, Keiji Nogami

Find the Full Article on RPTH.”

RPTH

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Bleeding Disorder Eisuke Takami Emicizumab Factor IX Factor X Health Hematology Hemophilia Hemophilia A Hemostasis Hemostasis Today Hirotoshi Nakano International Society on Thrombosis and Haemostasis ISTH Keiji Nogami Medicine Mitsumasa Osuna Rare Disease rpth RPTH Journal thrombosis thrombosis risk Yuto Nakajima
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