Document Detail


Effective management of refractory postcardiotomy bleeding with the use of recombinant activated factor VII.
MedLine Citation:
PMID:  17062247     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Severe coagulopathy after cardiovascular surgery may lead to intractable bleeding and is associated with increased mortality and morbidity. Recent studies have suggested that recombinant activated factor VII (rFVIIa) may play a role in decreasing postoperative bleeding. Herein we report our experience with the off-label use of rFVIIa in patients with refractory postcardiotomy bleeding. METHODS: From June 2003 to December 2005, 17 patients (mean age, 65 +/- 18 years) received rFVIIa for refractory bleeding after cardiac surgery. Preoperative risk factors for bleeding included reoperation (n = 7), emergency surgery (n = 7), and renal or hepatic failure (n = 3). Surgical procedures were aortic surgery (n = 7), complex valve operations (n = 7), coronary artery bypass grafting (n = 2), and cardiac tumor resection (n = 1). RESULTS: The average dose of rFVIIa was 103.1 +/- 30.2 microg/kg. After the administration of rFVIIa the blood loss was reduced and chest tube output decreased from an average of 300 mL/h to 60 mL/h (p = 0.024). Coagulation variables normalized (mean prothrombin time, 18 +/- 7 versus 14 +/- 3 seconds; p = 0.03; mean partial thromboplastin time, 94 +/- 50 versus 49 +/- 14 seconds; p = 0.02), and the need for blood products was significantly reduced. Only 1 patient required mediastinal reexploration. No thromboembolic complications occurred during hospitalization. CONCLUSIONS: This study suggests that rFVIIa is safe and efficacious in the management of refractory postcardiotomy bleeding. The use of rFVIIa is associated with reduced blood loss, rapid improvement of coagulation variables, and decreased need for blood products. Further studies are necessary to determine the safety and efficacy of this new hemostatic agent and its precise role in the treatment of severe postoperative coagulopathy.
Authors:
Farzan Filsoufi; Javier G Castillo; Parwis B Rahmanian; Corey Scurlock; Gregory Fischer; David H Adams
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  82     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-10-25     Completed Date:  2006-11-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1779-83     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiothoracic Surgery, Mount Sinai Hospital, New York, New York 10029, USA. farzan.filsoufi@mountsinai.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Blood Coagulation Disorders / drug therapy*,  etiology
Cardiac Surgical Procedures / adverse effects*
Factor VII / therapeutic use*
Factor VIIa
Hemostatics / therapeutic use*
Humans
Male
Middle Aged
Postoperative Hemorrhage / drug therapy*,  etiology
Recombinant Proteins / therapeutic use
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Hemostatics; 0/Recombinant Proteins; 0/recombinant FVIIa; 9001-25-6/Factor VII; EC 3.4.21.21/Factor VIIa

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