Recombinant factor VIIa in the treatment of non-hemophiliac bleeding.
OBJECTIVE
To review the clinical evidence for the use of recombinant factor VIIa (rFVIIa) in the prevention and/or treatment of bleeding in non-hemophiliac patients.


METHODS
A MEDLINE search (1966-December 2004) was conducted to identify pertinent literature. Results were limited to English-language reports and clinical trials. References of relevant articles and selected abstracts presented at scientific meetings were also reviewed.


METHODS
Human data from prospective and retrospective studies that examined the hemostatic effect of rFVIIa in non-hemophiliac patients were reviewed, with a focus on surgical prophylaxis, liver disease, intractable bleeding associated with trauma and surgery, and anticoagulation reversal.


RESULTS
Results from limited controlled trials on the use of rFVIIa as an adjunct for prevention of bleeding in surgery and liver diseases have not been consistent. For treatment of intractable bleeding, earlier use of rFVIIa in one trauma trial was shown to decrease the number of blood transfusions, but no differences in terms of clinical outcomes were observed in all trials. Controlled trials do not suggest an increased risk of thrombotic events. Optimal dosing and timing of administration have yet to be defined.


CONCLUSIONS
Until further prospective controlled data are available, it is recommended that conventional intervention for prevention and control of hemorrhage in non-hemophiliac patients should remain the standard of care. Close monitoring of coagulation parameters is recommended before, during, and after therapy, especially in high-risk patients. Pharmacoeconomic analysis may be useful to help control costs and maximize clinical benefits.
Lam
Masha S H
MS
Hematology/Oncology, Shands, University of Florida, Gainesville, FL, USA. lamsh@shands.ufl.edu
Sims-McCallum
Rosalyn P
RP
D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005167:Factor VII / Q000009:adverse effects / Q000627:therapeutic use*; D015942:Factor VIIa; D006470:Hemorrhage / Q000188:drug therapy* / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D016031:Liver Transplantation; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use
D011994:Recombinant Proteins; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa