title: Small dose of recombinant factor VIIa (rFVIIa) to perform percutaneous liver biopsies in cirrhotic patients.
abstract: Low levels of vitamin K-dependent coagulation factors, synthesized in the liver, play a key role in the hypocoagulable state of end-stage liver disease patients. Recombinant factor VII (rFVIIa) has been developed for, and currently is used in the treatment of patients with hemophilia A and B with inhibitors. Some experience was gained with rFVIIa in liver diseases since 1995. We used a low dose of rFVIIa to perform percutaneous liver biopsy in three patients, all of them with abnormal coagulation, impeditive of the percutaneous liver biopsy. The first one was a 29 years old man with alcoholic cirrhosis and a liver nodule; the second was a 32 years old man with post hepatitis C cirrhosis and excessive alcohol intake; the third was a 53 years old man with chronic hepatitis C and a congenital deficit of factor VII. A single dose of 5 micrograms/Kg of rFVII administered before liver biopsies raised levels of factor VII to acceptable values during more than 5 hours in the first two patients. We conclude that a small dose of rFVIIa can be enough to correct the abnormal coagulation of cirrhotic patients, permits percutaneous liver biopsy, and is cost-effective, compared to transjugular access.
authors.affiliation: Serviço de Medicina III, Hospitais da Universidad de Coimbra, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Carvalho
authors.forename: J
authors.initials: J
authors.lastname: Leitão
authors.forename: E
authors.initials: E
authors.lastname: Louro
authors.forename: R
authors.initials: R
authors.lastname: Maia
authors.forename: C
authors.initials: C
authors.lastname: Geraldes
authors.forename: C
authors.initials: C
authors.lastname: Ventura
authors.forename: M
authors.initials: M
authors.lastname: Silvestre
authors.forename: A
authors.initials: A
authors.lastname: Porto
mesh_terms: D000328:Adult; D001706:Biopsy / Q000009:adverse effects*; D001778:Blood Coagulation Disorders / Q000150:complications; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005167:Factor VII / Q000008:administration & dosage*; D015942:Factor VIIa; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011994:Recombinant Proteins / Q000008:administration & dosage*
chemical_list: D011994:Recombinant Proteins; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa