title: Use of recombinant factor VIIa for emergency reversal of anticoagulation.
abstract: BACKGROUND
  There is limited data regarding the use of activated recombinant factor VII (rFVIIa) in anticoagulated patients requiring reversal.
  
  
  OBJECTIVE
  To identify and describe characteristics of subjects who received rFVIIa as part of emergency treatment aimed at improving hemostasis.
  
  
  METHODS
  Data was obtained from an international peer-reviewed registry haemostasis.com. This registry contains data reported by physicians, who had elected to use rFVIIa to control bleeding in an emergency clinical situation. The contributors' approval for inclusion in the study was obtained and they were requested to validate and update information.
  
  
  METHODS
  Database review of cases receiving rFVIIa to manage bleeding coherent with the use of anticoagulant therapy.
  
  
  METHODS
  The Wilcoxon signed rank test was used to compare requirements for blood products and crystalloids/colloids during the 24h preceding and following rFVIIa administration, as well as changes in the levels of clotting factors during that period.
  
  
  RESULTS
  Eighteen patients were treated with rFVIIa (median dose: 87.35 microg/kg; range: 20.0-106.0 microg/kg) for bleeding. Anticoagulants requiring reversal included low-molecular-weight heparin (n = 6), unfractionated heparin (n =8), coumarin (n =3) and warfarin (n=1). All patients had failed to respond to traditional antidotes and blood products. Following administration, bleeding stopped in 10, markedly decreased in five and slowed in the remaining three. Amongst 12/16 patients, a response was observed within 2.0 h of first administration. The requirement for blood products and crystalloids/colloids decreased ( P < 0.05) after rFVIIa administration. rFVIIa was well tolerated.
  
  
  CONCLUSIONS
  rFVIIa may play a role in control of untoward bleeding in subjects receiving anticoagulation therapy.
authors.affiliation: Centre for Hemophilia and Thrombosis, University Hospital Skejby, Denmark. ingerslev@ki.au.dk
authors.forename: J
authors.initials: J
authors.lastname: Ingerslev
authors.forename: T
authors.initials: T
authors.lastname: Vanek
authors.forename: S
authors.initials: S
authors.lastname: Culic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D001777:Blood Coagulation / Q000187:drug effects*; D003029:Coagulants / Q000008:administration & dosage*; D004630:Emergencies; D005167:Factor VII / Q000008:administration & dosage*; D015942:Factor VIIa; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy*; D006706:Homeostasis; D006801:Humans; D016247:Information Storage and Retrieval; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage; D012042:Registries
chemical_list: D000925:Anticoagulants; D003029:Coagulants; D011994:Recombinant Proteins; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa