title: Successful reversal of deleterious coagulopathy by recombinant factor VIIa.
abstract: Effective treatment of severe or uncontrolled bleeding is a challenge for physicians in the operating room and intensive care unit. However, even aggressive conventional therapy may ultimately fail in some patients. Administration of recombinant activated factor VII (rFVIIa) may be the only remaining therapeutic option to stop life-threatening coagulopathic bleeding. We here describe the clinical course of 5 patients exhibiting severe continuous bleeding that could not be stopped by surgical intervention and appropriate hemostatic management but resolved after a mean dose of 90 microg/kg of rFVIIa (range, 90-120 microg/kg). Four of the five patients recovered completely, and one patient died after developing sepsis in multiorgan failure. In all patients, bleeding from wound surfaces stopped within minutes of the administration of rFVIIa. Coagulation measurements improved, and transfusion requirements declined considerably. No adverse effects associated with rFVIIa were observed.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Haas
authors.forename: Petra
authors.initials: P
authors.lastname: Innerhofer
authors.forename: Gabriele
authors.initials: G
authors.lastname: Kühbacher
authors.forename: Dietmar
authors.initials: D
authors.lastname: Fries
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000002:abnormalities; D001024:Aortic Valve Stenosis / Q000150:complications; D001778:Blood Coagulation Disorders / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D015942:Factor VIIa / Q000627:therapeutic use*; D017809:Fatal Outcome; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006470:Hemorrhage / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications; D019106:Postoperative Hemorrhage / Q000188:drug therapy; D011994:Recombinant Proteins / Q000627:therapeutic use; D013406:Suicide, Attempted
chemical_list: D011994:Recombinant Proteins; D015942:Factor VIIa