title: Successful treatment of severe gastrointestinal bleeding secondary to Crohn disease with recombinant factor VIIa.
abstract: A 58-year-old man diagnosed with ileocolonic Crohn disease was admitted to the emergency room with massive lower gastrointestinal hemorrhage and hypovolemic shock. Treatment was started with methylprednisolone, metronidazole and omeprazole. Within the next 24 hours, he received a total of 9 U of red blood cell concentrate and 2 U of fresh frozen plasma. Because of persistence of bleeding, hypovolemic shock and life-threatening situation, we started therapy with rFVIIa. One dose of 120 microg/kg and another dose of 120 microg/kg three hours after the first dose were administered as compassionate use, with resolution of bleeding in the next 12 hours. On day 4 the patient was stabilized. We performed a total colonoscopy and intubation of the ileocecal valve that showed patchy deep ulcerations in the rectum with bleeding inflammatory pseudopolyps. Acute gastrointestinal bleeding is an unusual complication in Crohn disease. In this case, the use of recombinant activated factor VIIa controlled the massive gastrointestinal bleeding secondary to Crohn disease and without clinically significant adverse effect. There are few case reports documenting the use of recombinant activated factor VIIa for this type of off-label indication. Clinical trials should be carried out to define the dosage and dose interval schedule of rFVIIa in the treatment of uncontrolled massive gastrointestinal bleeding secondary to Crohn disease.
authors.affiliation: Gastroenterology Section, Critical Care Unit, Hospital General Universitario de Elche, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Girona
authors.forename: Joaquín
authors.initials: J
authors.lastname: Borrás-Blasco
authors.forename: Venancio
authors.initials: V
authors.lastname: Conesa-García
authors.forename: Andrés
authors.initials: A
authors.lastname: Navarro-Ruiz
authors.forename: Javier
authors.initials: J
authors.lastname: Solís
authors.forename: Mariana Fe
authors.initials: MF
authors.lastname: García-Sepulcre
authors.forename: Israel
authors.initials: I
authors.lastname: Oliver-García
mesh_terms: D003424:Crohn Disease / Q000150:complications*; D005167:Factor VII / Q000627:therapeutic use*; D015942:Factor VIIa; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D011994:Recombinant Proteins; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa