Potential role of recombinant activated factor VII for the treatment of severe bleeding associated with disseminated intravascular coagulation: a systematic review.
Recombinant activated factor VII (rFVIIa) is a novel hemostatic agent, originally developed for the treatment of hemorrhage in hemophiliacs with inhibitors, which has been successfully used recently in an increasing number of nonhemophilic bleeding conditions. In the present systematic review we report the existing literature data on the use of this hemostatic agent in severe bleeding, unresponsive to standard treatment, associated with disseminated intravascular coagulation. A total of 99 disseminated intravascular coagulation-associated bleeding episodes treated with rFVIIa were collected from 27 published articles: in the majority of the cases, the underlying disorder complicated by disseminated intravascular coagulation was a postpartum hemorrhage, while in the remaining cases it was a cancer, trauma, sepsis or liver failure. Although limited, the data available suggest that rFVIIa could have a potential role in this clinical setting. Large randomized trials are needed, however, to confirm the preliminary results and to assess the safety and dosing regimens of this agent in refractory bleeding associated with disseminated intravascular coagulation.
Franchini
Massimo
M
Immunohematology and Transfusion Center, City Hospital of Verona, Italy. mfranchini@univr.it
Manzato
Franco
F
Salvagno
Gian Luca
GL
Lippi
Giuseppe
G
D000328:Adult; D015984:Causality; D002648:Child; D015897:Comorbidity; D004211:Disseminated Intravascular Coagulation / Q000188:drug therapy* / Q000401:mortality; D005167:Factor VII / Q000494:pharmacology / Q000627:therapeutic use*; D005168:Factor VII Deficiency / Q000188:drug therapy / Q000401:mortality; D015942:Factor VIIa; D005260:Female; D017359:HELLP Syndrome / Q000188:drug therapy / Q000401:mortality; D006490:Hemostatics / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000188:drug therapy / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000188:drug therapy / Q000401:mortality; D006473:Postpartum Hemorrhage / Q000188:drug therapy / Q000401:mortality; D011247:Pregnancy; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use; D015996:Survival Rate
D006490:Hemostatics; D011994:Recombinant Proteins; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa