Early use of factor VIIa in cardiac surgery is associated with lower rates of blood transfusions without impact on outcome

Introduction

Bleeding after cardiac surgery is a common state, associated with adverse effects. Factor VIIa is a recombinant factor able to restore blood coagulation without significant adverse effects. We aimed to evaluate whether the early use of factor VIIa reduces bleeding and the rates of transfusion.

Methods

We studied 241 patients submitted to cardiac surgery who presented bleeding after heparin reversal and a first replacement of clotting factors. From these, 81 patients were submitted to valve procedures, 51 coronary artery bypass surgery (CABG), 60 valve + CABG, 35 aortic ascending surgery and 14 cardiac transplant. From these, 131 received factor VIIa early (in the intraoperative room) and 110 received the drug in the ICU.

Results

Both groups of patients presented a statistically significant reduction of blood transfusion after receiving factor VIIa (P < 0.001). The group of patients undergoing early use presented a lower rate of reoperations due to bleeding (P < 0.01), and received less units of red blood cells (P < 0.01), fresh frozen plasma (P < 0.01), cryoprecipitate and platelets (P < 0.01). Also, we detected a low incidence of infection in the group who received the factor in intraoperative room.

Conclusions

Early use of factor VIIa in patients who bleed after cardiac surgery is associated with lower rates of reoperations, lower rates of transfusion and lower incidence of infection. This suggests the drug should not be used as a last therapeutic tool and may be indicated earlier in the management of bleeding.