Recombinant activated factor VII for the rapid correction of coagulopathy in nonhemophilic neurosurgical patients.
OBJECTIVE
Coagulopathy is a significant contraindication for neurosurgery. Unfortunately, many coagulopathic patients require urgent neurosurgical intervention. Standard use of blood products, including fresh-frozen plasma or prothrombin complexes, to correct the coagulopathy often leads to significant delays in treatment. Recombinant activated factor VII (rFVIIa) is a medication originally designed to treat bleeding in hemophiliacs but also seems to correct a wide variety of coagulopathies rapidly and safely in nonhemophilic patients.


METHODS
The medical records of nine patients with coagulopathy requiring urgent neurosurgical intervention were reviewed retrospectively. Each patient was given a dose ranging from 40 to 90 microg/kg of rFVIIa before undergoing surgery. Pre-rFVIIa coagulation and post-rFVIIa coagulation parameters were obtained. Once correction of the coagulopathy was verified, each patient underwent the appropriate neurosurgical procedure.


RESULTS
The average age of the patients was 40.9 years; six were women. The causes of the coagulopathy included anticoagulant medication, liver dysfunction, and dilutional coagulopathy after traumatic hemorrhage. Neurosurgical indications included intraparenchymal/intraventricular hemorrhage, hydrocephalus, diffuse cerebral edema, and epidural hematoma. Post-rFVIIa coagulation parameters obtained as early as 20 minutes after infusion of the medication showed normalization of values. There were no procedural or operative complications and no postoperative hemorrhagic complications. No associated thromboembolic or other complications with the use of rFVIIa were observed.


CONCLUSIONS
The use of rFVIIa for the urgent surgical treatment of coagulopathic patients is quite promising. Further studies, including randomized, prospective trials using rFVIIa to address issues such as optimal dosing, efficacy, surgical indications, cost-effectiveness, morbidity, and mortality are needed.
Park
Paul
P
Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan 48109, USA. ppark@umich.edu
Fewel
Matthew E
ME
Garton
Hugh J
HJ
Thompson
B Gregory
BG
Hoff
Julian T
JT
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001778:Blood Coagulation Disorders / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D000075202:Contraindications; D015942:Factor VIIa / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006467:Hemophilia A / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D019635:Neurosurgical Procedures; D017063:Outcome Assessment, Health Care; D011300:Preoperative Care; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D011994:Recombinant Proteins; D015942:Factor VIIa