Vascular injury and thrombotic potential: a note of caution about recombinant factor VIIa.
Postoperative hemorrhage following cardiac surgery increases morbidity, mortality, and costs. Several case reports have described the successful use of recombinant factor VIIa to decrease or stop bleeding in patients undergoing cardiac surgery. The mechanism of action of recombinant factor VIIa is thought to be increased site-specific thrombin generation by tissue factor-mediated activation of coagulation or from activated platelets. However, there have also been many reports of thrombotic complications after recombinant factor VIIa administration. Randomized clinical trials and further laboratory studies should help better clarify the efficacy, safety, cost-effectiveness, and optimal dosing of recombinant factor VIIa in the cardiac surgical setting.
Mazer
C David
CD
Department of Anesthesia, St Michael's Hospital, University of Toronto, Ontario, Canada . mazerd@smh.toronto.on.ca
Leong-Poi
Howard
H
Mahoney
James
J
Latter
David
D
Strauss
Bradley H
BH
Teitel
Jerome M
JM
D001777:Blood Coagulation / Q000187:drug effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003029:Coagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D015942:Factor VIIa / Q000008:administration & dosage / Q000009:adverse effects* / Q000191:economics; D006801:Humans; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D013927:Thrombosis / Q000139:chemically induced
D003029:Coagulants; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa