The use of recombinant factor VIIa for severe intractable bleeding during spine surgery.
METHODS
A report on the use of recombinant activated factor VII in 4 patients who developed severe intractable bleeding and coagulopathy during spine surgery.


OBJECTIVE
To describe the role of recombinant activated factor VII for hemostasis during spine surgery.


BACKGROUND
Recombinant activated factor VII is indicated for the treatment of bleeding episodes and the prevention of bleeding during surgery in patients with hemophilia with inhibitors. However, its use in adults undergoing spine surgery has not yet been reported.


METHODS
Four patients who underwent multilevel spine surgery through an anterior approach incurred massive bleeding and subsequently became coagulopathic. Standard hemostatic techniques were performed and blood products were transfused. Persistence of the bleeding prompted the use of recombinant activated factor VII.


RESULTS
Treatment with recombinant activated factor VII led to an improvement in prothrombin time and partial thromboplastin time and brought about cessation in gross, nonsurgical bleeding intraoperatively. No clinically relevant thrombotic complications related to the drug were noted.


CONCLUSIONS
Recombinant activated factor VII is promising as an adjunctive hemostatic agent for patients with perioperative bleeding problems during spine surgery. Efficacy is seen even at low doses.
Kaw
Leoncio L
LL
Division of Trauma and Critical Care, Department of Surgery, University of California San Diego Medical Center, San Diego, California 92103-8896, USA.
Coimbra
Raul
R
Potenza
Bruce M
BM
Garfin
Steve R
SR
Hoyt
David B
DB
D000328:Adult; D000368:Aged; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005167:Factor VII / Q000627:therapeutic use*; D015942:Factor VIIa; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use*; D013131:Spine / Q000601:surgery*
D011994:Recombinant Proteins; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa