Document Detail


A critical review on the use of recombinant factor VIIa in life-threatening obstetric postpartum hemorrhage.
MedLine Citation:
PMID:  18393147     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The objective of this review was to evaluate and summarize the current literature on the unlicensed use of the novel agent recombinant activated factor VII (rFVIIa) in the management of major postpartum hemorrhage. After a systematic electronic search without temporal limits on MEDLINE, EMBASE, OVID and SCOPUS, the bibliographic references of all retrieved studies and reviews were additionally assessed for further reports of clinical trials. Unpublished works were also identified by searching abstracts from the most eminent conferences on this topic. In total, there were 31 studies that fulfilled our inclusion criteria. These studies incorporated 118 cases of massive postpartum hemorrhage treated with rFVIIa. The median age of the patients was 31.4 years, and cesarean section appeared to increase the risk of postpartum hemorrhage. At a median dose of 71.6 mug/kg, rFVIIa was reported to be effective in stopping or reducing bleeding in nearly 90% of the reported cases. Based on the evidence from the literature, we give some recommendations on the use of rFVIIa in massive postpartum hemorrhage. Nevertheless, although these reports suggest the potential role of rFVIIa in treating massive postpartum hemorrhage refractory to standard therapy, we advise particular caution in interpreting these results, as they are derived from few and uncontrolled studies. Further evidence is needed using well-designed clinical trials to better assess the optimal dose, the effectiveness, and the safety of rFVIIa in such critical bleeding conditions.
Authors:
Massimo Franchini; Massimo Franchi; Valentino Bergamini; Gian Luca Salvagno; Martina Montagnana; Giuseppe Lippi
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Seminars in thrombosis and hemostasis     Volume:  34     ISSN:  0094-6176     ISO Abbreviation:  Semin. Thromb. Hemost.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-04-08     Completed Date:  2008-06-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0431155     Medline TA:  Semin Thromb Hemost     Country:  United States    
Other Details:
Languages:  eng     Pagination:  104-12     Citation Subset:  IM    
Affiliation:
Servizio di Immunoematologia e Trasfusione - Centro Emofilia, Azienda Ospedaliera di Verona, Verona; Italy. massimo.franchini@azosp.vr.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Algorithms
Clinical Protocols
Clinical Trials as Topic
Critical Illness
Factor VIIa / administration & dosage,  adverse effects,  therapeutic use*
Female
Humans
Postpartum Hemorrhage / blood,  drug therapy*
Pregnancy
Recombinant Proteins / administration & dosage,  adverse effects,  therapeutic use
Safety
Chemical
Reg. No./Substance:
0/Recombinant Proteins; EC 3.4.21.21/Factor VIIa

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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