Recombinant-activated factor VII as hemostatic therapy in eight cases of severe hemorrhage from esophageal varices.
OBJECTIVE
There are several treatment options for gastroesophageal variceal hemorrhage. In severe cases, bleeding persists and is associated with a dismal outcome. The coagulation disorders might be correlated with risk of bleeding in patients with portal hypertension. The administration of activated recombinant factor VII corrects prothrombin time transiently in nonbleeding patients with cirrhosis as well as in bleeding ones. The aim of this study was to assess the hemostatic efficacy of activated recombinant factor VII in bleeding esophageal varices.


METHODS
Between May 2001 and September 2002, 112 patients with cirrhosis and an episode of acute esophageal variceal bleeding were admitted. On an open basis with a single intravenous dose of 4.8 mg of recombinant factor VII, we treated 8 patients experiencing severe and active hemorrhage from esophageal varices unresponsive to pharmacologic therapy, endoscopic therapy, or balloon tamponade.


RESULTS
Eight (7%) of 112 patients met entry criteria. Hemostasis was achieved in all the cases after recombinant activated factor VII therapy. Rebleeding and mortality rates were 25% and 50% (2 and 4 patients), respectively.


CONCLUSIONS
In our experience, recombinant activated factor VII achieves hemostasis in bleeding esophageal varices unresponsive to standard treatment.
Romero-Castro
Rafael
R
Division of Gastroenterology, Virgen Macarena Hospital, Av. Dr. Fedriani 3, 41009 Seville, Spain. romeror@medynet.com
Jimenez-Saenz
Manuel
M
Pellicer-Bautista
Francisco
F
Gomez-Parra
Manuel
M
Argüelles Arias
Federico
F
Guerrero-Aznar
Maria D
MD
Sendon-Perez
Angel
A
Herrerias-Gutierrez
Juan M
JM
D000368:Aged; D000369:Aged, 80 and over; D021721:Balloon Occlusion; D002404:Catheterization; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000401:mortality / Q000628:therapy*; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality / Q000628:therapy*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011517:Prothrombin Time; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012008:Recurrence; D012720:Severity of Illness Index; D013030:Spain; D016019:Survival Analysis; D016896:Treatment Outcome
D006490:Hemostatics; D011994:Recombinant Proteins; D015942:Factor VIIa