Recombinant factor VIIa improves coagulopathy caused by liver failure.
OBJECTIVE
Coagulopathy is an important cause of morbidity and mortality in patients with liver failure. The benefit of traditional therapies to correct coagulation is often limited and short-lived. Our aim is to identify indications for rFVIIa use and the outcome of treatment in children with liver failure.


METHODS
A retrospective review from July 2000 to December 2001 was performed to identify consecutive patients with acute or chronic liver failure who received rFVIIa. Prothrombin times (PT) before and after therapy were compared by paired t test.


RESULTS
Fifteen patients were treated with rFVIIa for coagulopathy caused by liver failure. All were receiving fresh frozen plasma (mean infusion rate, 39.7 mL/kg/day) when rFVIIa therapy was started. The mean PT before rFVIIa was 32.0 +/- 7.0 seconds. One hour after infusion, the PT normalized to 13.7 +/- 2.4 seconds (P < 0.0001) and remained significantly reduced at 6 hours (19.8 +/- 5.3 seconds; P < 0.0001). A sustained improvement was maintained during the subsequent 3 days. Five of seven patients with bleeding complications improved clinically after rFVIIa treatment. Two of the bleeding patients also benefited from improved fluid balance as fresh frozen plasma support was reduced. No thrombotic events were attributed to rFVIIa therapy.


CONCLUSIONS
In patients with liver failure, rFVIIa therapy quickly normalizes the PT and maintains improved hemostasis, even when coagulopathy has been refractory to fresh frozen plasma. Therapy subjectively reduces clinical bleeding and can improve fluid balance, without complications.
Brown
Jeffrey B
JB
Department of Gastroenterology, Hepatology, and Nutrition, Children's Memorial Hospital, Northwestern University, Feinberg School of Medicine, Chicago, IL 60614, USA.
Emerick
Karan M
KM
Brown
Deborah L
DL
Whitington
Peter F
PF
Alonso
Estella M
EM
D000293:Adolescent; D001778:Blood Coagulation Disorders / Q000188:drug therapy* / Q000209:etiology; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D005167:Factor VII / Q000009:adverse effects / Q000627:therapeutic use*; D015942:Factor VIIa; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017093:Liver Failure / Q000150:complications*; D008297:Male; D011517:Prothrombin Time; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D011994:Recombinant Proteins; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa