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Factor VIIa for severe cardiac surgical bleeding

Introduction

Severe perioperative bleeding in cardiac surgery is multifactorial in origin. Recombinant factor VIIa (rFVIIa; Novo Nordisk, Denmark) has been used perioperatively since 1988 [1]. It promotes formation of blood clots by a range of actions. We have recently introduced it into our cardiac surgical programme for severe intractable coagulopathic bleeding.

Purpose of study

To assess efficacy and safety of rFVIIa in cardiac surgery by chart review.

Methods

Charts for the seven patients who received rFVIIa were reviewed for effects on clinical status, blood loss and transfusion need.

Results

Seven adult patients had received rFVIIa for severe cardiac surgical bleeding by February 2002. Five of these survived to hospital discharge. Of the two deaths, one patient died of continued haemorrhage on the operating table, and the other died at 5 days postoperation from multiple organ failure. The median total dose of rFVIIa administered was 22 μg/kg (range, 13–75 μg/kg). There were marked reductions in estimated hourly blood loss from a median 952 ml/hour (range, 182–1500 ml/hour) to a median 19 ml/hour (range, 7–41 ml/hour) after rFVIIa in the survivors. Reductions in blood product use were also noted (Table 1).

Table 1 Median units of blood product used for the five surviving patients (range)

Conclusions

There have been two published reports on the use of rFVIIa in cardiac surgery involving one and five patients, respectively [2,3]. In this review, we have found that five out of seven patients all with severe perioperative bleeding appeared to benefit from the administration of rFVIIa. There were no thrombotic complications noted. Further research into the optimal role for rFVIIa in cardiac surgery is justified.

References

  1. 1.

    Hedner U, Glazer S, Pingel K, et al.: Successful use of recombinant factor VIIa in patient with severe haemophilia A during synovectomy [letter]. Lancet 1988, 2: 1193. 10.1016/S0140-6736(88)90259-0

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  2. 2.

    Hendriks HG, van der Maaten JM, de Wolf J, et al.: An effective treatment of severe intractable bleeding after valve repair by one single dose of activated recombinant factor VII. Anesth Analg 2001, 93: 287-289. 10.1097/00000539-200108000-00009

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    Al Douri M, Shafi T, Al Khudairi D, et al.: Effect of the administration of recombinant activated factor VII (rFVIIa; NovoSeven) in the management of severe uncontrolled bleeding in patients undergoing heart valve replacement surgery. Blood Coagul Fibrinolysis 2000,11(suppl 1):S121-S127.

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Diprose, P., Herbertson, M., O'Shaughnessy, D. et al. Factor VIIa for severe cardiac surgical bleeding. Crit Care 6, 6 (2002). https://doi.org/10.1186/cc1810

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Keywords

  • Blood Loss
  • Hospital Discharge
  • Organ Failure
  • Blood Clot
  • Chart Review