title: Recombinant activated factor VII: a solution to refractory haemorrhage in vascular surgery?
abstract: OBJECTIVE
  Post-operative haemorrhage is a recognised complication and independent predictor of outcome in complex vascular surgery. The off-license administration of activated Recombinant Factor VII (rFVIIa) to treat haemorrhage in other surgical settings has been investigated, but concerns over potential adverse events have limited its use in vascular surgery. This article reports rFVIIa's method of action and systematically reviews rFVIIa's role in complex vascular surgery.
  
  
  METHODS
  A systematic literature search identified articles reporting on rFVIIa administration within vascular surgery patients. Patient-specific data regarding transfusion requirements was extracted and pooled statistical analysis performed.
  
  
  RESULTS
  15 articles reporting 43 patients were identified. RFVIIa has been administered in open and endovascular procedures and in both elective and emergency settings. Major aortic surgery accounted for 75% of cases. The range of rFVIIa administered as a cumulative dose was large, as was the variation in initial dose. Transfusion data from 9 patients was pooled and analysed. Significant differences were found between pre- and post- rFVIIa for packed red cell transfusions (mean 29.2 vs. 8.2, p=0.015). Intra-arterial thrombosis was reported in 3 cases.
  
  
  CONCLUSIONS
  RFVIIa may reduce haemorrhage in selected vascular surgical patients. Randomized controlled trials are justified to definitively investigate its role within this setting.
authors.affiliation: Department of BioSurgery and Surgical Technology, Imperial College, London, United Kingdom. o.warren@imperial.ac.uk
authors.forename: O J
authors.initials: OJ
authors.lastname: Warren
authors.forename: E M H
authors.initials: EM
authors.lastname: Alcock
authors.forename: A M T L
authors.initials: AM
authors.lastname: Choong
authors.forename: D R
authors.initials: DR
authors.lastname: Leff
authors.forename: I
authors.initials: I
authors.lastname: Van Herzeele
authors.forename: A W
authors.initials: AW
authors.lastname: Darzi
authors.forename: T
authors.initials: T
authors.lastname: Athanasiou
authors.forename: N J W
authors.initials: NJ
authors.lastname: Cheshire
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003029:Coagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D017707:Erythrocyte Transfusion; D015942:Factor VIIa / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012107:Research Design; D013927:Thrombosis / Q000139:chemically induced; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D003029:Coagulants; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa