title: Recombinant-activated factor VII as hemostatic therapy in eight cases of severe hemorrhage from esophageal varices.
abstract: 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.
authors.affiliation: Division of Gastroenterology, Virgen Macarena Hospital, Av. Dr. Fedriani 3, 41009 Seville, Spain. romeror@medynet.com
authors.forename: Rafael
authors.initials: R
authors.lastname: Romero-Castro
authors.forename: Manuel
authors.initials: M
authors.lastname: Jimenez-Saenz
authors.forename: Francisco
authors.initials: F
authors.lastname: Pellicer-Bautista
authors.forename: Manuel
authors.initials: M
authors.lastname: Gomez-Parra
authors.forename: Federico
authors.initials: F
authors.lastname: Argüelles Arias
authors.forename: Maria D
authors.initials: MD
authors.lastname: Guerrero-Aznar
authors.forename: Angel
authors.initials: A
authors.lastname: Sendon-Perez
authors.forename: Juan M
authors.initials: JM
authors.lastname: Herrerias-Gutierrez
mesh_terms: 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
chemical_list: D006490:Hemostatics; D011994:Recombinant Proteins; D015942:Factor VIIa