Probable right atrial thrombus immediately after recombinant activated factor VII administration.
We report the finding of a probable right atrial thrombus in a 33-yr-old male patient with severe head, chest, and abdominal trauma. Refractory coagulopathy and gross haemodynamic instability ensued, which was only partially controlled with massive blood product transfusion and high-dose inotropic support during laparotomy. Continuous transoesophageal echocardiography revealed a probable atrial thrombus partially occluding the right ventricular inflow tract, which appeared immediately after the patient received 100 microg kg(-1) of recombinant activated factor VII (rFVIIa) via a left internal jugular central line. This is the first report documenting an immediate temporal relationship between rFVIIa administration and a space-occupying lesion compatible with localized thrombosis, despite ongoing severe systemic coagulopathy. We review the clinical use of rFVIIa and discuss possible factors contributing to this event.
Pang
G
G
Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, Queensland 4006, Australia. georgepang@hotmail.com
Donaldson
A
A
D000328:Adult; D003029:Coagulants / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D005167:Factor VII / Q000009:adverse effects*; D015942:Factor VIIa; D006325:Heart Atria / Q000000981:diagnostic imaging; D006331:Heart Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000628:therapy; D011994:Recombinant Proteins / Q000009:adverse effects; D013927:Thrombosis / Q000139:chemically induced* / Q000000981:diagnostic imaging
D003029:Coagulants; D011994:Recombinant Proteins; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa