FVIIa corrects the coagulopathy of fulminant hepatic failure but may be associated with thrombosis: a report of four cases.
OBJECTIVE
During liver transplantation, excessive blood losses are correlated with increased morbidity and mortality. Blood losses are particularly high in the case of urgent liver transplantation for fulminant hepatic failure (FHF). Recombinant activated factor VII (rFVIIa) has shown promise in treating the coagulopathy of liver disease. We review our experience with the use of rFVIIa in treating the coagulopathy of FHF during urgent liver transplantation.


METHODS
We report four patients with FHF who met King's College criteria for liver transplantation and in whom rFVIIa was used after conventional means for treating the associated coagulopathy had failed. In all patients, the coagulation defect was corrected by rFVIIa. However, thrombotic complications occurred in two patients (myocardial ischemia and portal vein thrombosis) and the implication of rFVIIa cannot be excluded.


CONCLUSIONS
We conclude that rFVIIa is effective in the correction of the coagulopathy associated with FHF. However, thrombotic events are of concern and therefore, further studies are warranted to define the safety of rFVIIa in that setting.
Pavese
Patricia
P
Department of Réanimation Médicale, CHU de Grenoble, Grenoble, France. PPavese@chu-grenoble.fr <PPavese@chu-grenoble.fr>
Bonadona
Agnès
A
Beaubien
Jean
J
Labrecque
Pascal
P
Pernod
Gilles
G
Letoublon
Christian
C
Barnoud
Didier
D
D000328:Adult; D000743:Anemia, Hemolytic / Q000150:complications; D001778:Blood Coagulation Disorders / Q000188:drug therapy* / Q000209:etiology*; D003550:Cystic Fibrosis / Q000150:complications; D015942:Factor VIIa / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy; D008103:Liver Cirrhosis / Q000150:complications; D017114:Liver Failure, Acute / Q000150:complications*; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D013927:Thrombosis / Q000139:chemically induced*
D011994:Recombinant Proteins; D015942:Factor VIIa