Successful treatment with rFVIIa of spontaneous intracerebral hemorrhage in a patient with mechanical prosthetic heart valves.
Intracerebral hemorrhage (ICH) is associated with high mortality in patients on oral anticoagulant treatment. The normalization of hemostatic balance usually requires slow-acting or risky treatments, such as vitamin K, fresh frozen plasma or prothrombin complex concentrates, which have narrow therapeutic windows particularly in cardiopathic patients like those with mechanical heart valves. Recombinant activated factor VII (rFVIIa) seems useful in patients with normal or pathologic coagulation who have an ICH. We report of a patient on acenocumarol for mitro-aortic valve replacement, referred for headache and found at computerized tomography scanning to have a parietal hemorrhage with ventricular invasion. International normalized ratio was 3.22. The patient was treated with vitamin K and with a bolus of 80 mug/kg of rFVIIa, with correction of the international normalized ratio within 15 min. Sequential computerized tomographies showed progressive reduction of the hematoma and normalization of ventricular spaces and the patient fully recovered. No valvular dysfunctions or cardiac thrombi were found at sequential echocardiograms. Neurological examination at 3 months follow-up visit was completely normal. To our knowledge, this is the first report of the safe and successful use of rFVIIa to treat ICH in a patient on oral anticoagulants for prosthetic heart valves.
Conti
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S
Sezione di Medicina Interna e Cardiovascolare, University of Perugia, via Enrico dal Pozzo, 06123 Perugia, Italy.
La Torre
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D
Gambelunghe
G
G
Ciorba
E
E
Iorio
A
A
D002543:Cerebral Hemorrhage / Q000188:drug therapy*; D005167:Factor VII / Q000627:therapeutic use*; D015942:Factor VIIa; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D020127:Recovery of Function; D013314:Stress, Mechanical; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome; D014812:Vitamin K / Q000627:therapeutic use
D011994:Recombinant Proteins; D014812:Vitamin K; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa