title: The role of recombinant factor VIIa in on-pump cardiac surgery: proceedings of the Canadian Consensus Conference.
abstract: OBJECTIVE
  Recombinant activated factor VII (rFVIIa) is currently not approved by Health Canada or the Food and Drug Administration for treating excessive blood loss in nonhemophiliac patients undergoing on-pump cardiac surgery, but is increasingly being used "off-label" for this indication. A Canadian Consensus Conference was convened to generate recommendations for rFVIIa use in on-pump cardiac surgery.
  
  
  METHODS
  The panel undertook a literature review of the use of rFVIIa in both cardiac and non-cardiac surgery. Appropriateness, timing, and dosage considerations were addressed for three cardiac surgery indications: prophylactic, routine, and rescue uses. Recommendations were based on evidence from the literature and derived by consensus following recognized grading procedures.
  
  
  RESULTS
  The panel recommended against prophylactic or routine use of rFVIIa, as there is no evidence at this time that the benefits of rFVIIa outweigh its potential risks compared with standard hemostatic therapies. On the other hand, the panel made a weak recommendation (grade 2C) for the use of rFVIIa (one to two doses of 35-70 microg.kg(-1)) as rescue therapy for blood loss that is refractory to standard hemostatic therapies, despite the lack of randomized controlled trial data for this indication.
  
  
  CONCLUSIONS
  In cardiac surgery, the risks and benefits of rFVIIa are unclear, but current evidence suggests that its benefits may outweigh its risks for rescue therapy in selected patients. Methodologically rigorous studies are needed to clarify its riskbenefit profile in cardiac surgery patients.
authors.affiliation: University Health Network, Toronto General Hospital, Department of Anesthesia, Toronto, Ontario, Canada. keyvan.karkouti@uhn.on.ca
authors.forename: Keyvan
authors.initials: K
authors.lastname: Karkouti
authors.forename: W Scott
authors.initials: WS
authors.lastname: Beattie
authors.forename: Mark A
authors.initials: MA
authors.lastname: Crowther
authors.forename: Jeannie L
authors.initials: JL
authors.lastname: Callum
authors.forename: Rosaleen
authors.initials: R
authors.lastname: Chun
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Fremes
authors.forename: Jérôme
authors.initials: J
authors.lastname: Lemieux
authors.forename: Vivian C
authors.initials: VC
authors.lastname: McAlister
authors.forename: Brian D
authors.initials: BD
authors.lastname: Muirhead
authors.forename: John M
authors.initials: JM
authors.lastname: Murkin
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Nathan
authors.forename: Bill I
authors.initials: BI
authors.lastname: Wong
authors.forename: Terrence M
authors.initials: TM
authors.lastname: Yau
authors.forename: Erik L
authors.initials: EL
authors.lastname: Yeo
authors.forename: Richard I
authors.initials: RI
authors.lastname: Hall
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D002170:Canada; D006348:Cardiac Surgical Procedures; D002986:Clinical Trials as Topic; D001026:Coronary Artery Bypass; D015942:Factor VIIa / Q000627:therapeutic use*; D006801:Humans; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D011994:Recombinant Proteins; D015942:Factor VIIa