Danazol in Hemophilia-Reply

In Reply.— Ambriz et al report on their experience with danazol in mild to moderate hemophilia. No significant increase in factor levels was noted in 18 of 20 patients receiving 800 mg/day of danazol. Two patients showed modest increases (6% to 10.5% and 2.8% to 6%), which could well be within the error range of repeated measurements or related to recent infusions of factor. We and others have noted similar results along with an increased bleeding tendency in hemophiliacs receiving danazol. 1-5 Thus, there are now four groups, in addition to ours, that have failed to demonstrate any useful or significant increase in factor levels produced by danazol. The mechanism of increased bleeding in some patients remains unclear, but one possibility is enhanced fibrinolysis, either localized or systemic, with the latter occasionally reflected in a shortened euglobulin lysis time (ELT). Ambriz et al used a fibrinolysis inhibitor, [unk]-aminocaproic acid, in