title: FVIIa corrects the coagulopathy of fulminant hepatic failure but may be associated with thrombosis: a report of four cases.
abstract: 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.
authors.affiliation: Department of Réanimation Médicale, CHU de Grenoble, Grenoble, France. PPavese@chu-grenoble.fr <PPavese@chu-grenoble.fr>
authors.forename: Patricia
authors.initials: P
authors.lastname: Pavese
authors.forename: Agnès
authors.initials: A
authors.lastname: Bonadona
authors.forename: Jean
authors.initials: J
authors.lastname: Beaubien
authors.forename: Pascal
authors.initials: P
authors.lastname: Labrecque
authors.forename: Gilles
authors.initials: G
authors.lastname: Pernod
authors.forename: Christian
authors.initials: C
authors.lastname: Letoublon
authors.forename: Didier
authors.initials: D
authors.lastname: Barnoud
mesh_terms: 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*
chemical_list: D011994:Recombinant Proteins; D015942:Factor VIIa