Use of NovoSeven^® in cases with massive bleeding following surgery with extracorporeal circulation

Bleeding complications still remain a real problem in patients undergoing long-time surgery with extracorporeal circulation. In these cases a large hemotransfusion is needed and the usual sequence with postoperative multiorganic failure affecting patient outcome.

Recombinant activated factor VII (rFVIIa; NovoSeven^®, Novo Nordisk A/S, Bagsvaerd, Denmark) was used in 15 patients undergoing open heart surgery or surgery for aorta and aortic arch aneurysms. All patients had normal coagulation parameters before surgery. In these patients massive bleeding (10–20 ml/min) have developed during intraoperative or early postoperative periods, but bloodloss rate have minimal reduction, despite infusions of fresh frozen plasma, cryoprecipitate plasma, platelet concentrate, Trasilol and e-aminocapronic acid.

After one-time recombinant FVIIa NovoSeven administration (the dose of rFVIIa ranged between 60 and 90 mg/kg body weight), bleeding disappeared in 14 patients. In one patient the bloodloss rate had been decreased from 20 to 5.5 ml/min and then repeated NovoSeven administration (90 mg/kg body weight) stopped the bleeding and simultaneously stabilized some hemocoagulating parameters.

rFVIIa (NovoSeven^®) may be used to effective treatment massive bleeding and to reduce the amount of transfused blood components in patients undergoing long-time surgery with extracorporeal circulation.