The evidence for the use of recombinant factor VIIa in massive bleeding: development of a transfusion policy framework.
A review of the recent randomized control trial evidence of the use of recombinant factor VIIa (rFVIIa) in massive bleeding. rFVIIa is a recombinant genetically engineered clotting factor that has been used for the management of haemophilia patients with inhibitors. There has been increasing use in patients with massive bleeding, even when there is no underlying coagulation disorder present. In November 2006, the Canadian National Advisory Committee on Blood and Blood Products engaged in a consultation and review process with several leading Canadian experts to review and discuss the current evidence up to November 2006. There is little evidence to support the routine use of rFVIIa in massive bleeding on review of 13 randomized controlled trials. rFVIIa should only be considered as part of a transfusion policy framework for massive bleeding after all other transfusion and supportive measures are considered. An example of a policy framework is presented.
Moltzan
C J
CJ
Department of Internal Medicine, St. Boniface General Hospital, Winnipeg, Manitoba, Canada. catherine.moltzan@cancercare.mb.ca
Anderson
D A
DA
Callum
J
J
Fremes
S
S
Hume
H
H
Mazer
C D
CD
Poon
M C
MC
Rivard
G
G
Rizoli
S
S
Robinson
S
S
D001777:Blood Coagulation; D001803:Blood Transfusion / Q000379:methods*; D002986:Clinical Trials as Topic; D005168:Factor VII Deficiency / Q000188:drug therapy; D015942:Factor VIIa / Q000235:genetics / Q000627:therapeutic use*; D050723:Fractures, Bone / Q000601:surgery; D006291:Health Policy; D006467:Hemophilia A / Q000188:drug therapy*; D002836:Hemophilia B / Q000188:drug therapy*; D006470:Hemorrhage / Q000188:drug therapy*; D006801:Humans; D010384:Pelvic Bones; D011994:Recombinant Proteins / Q000627:therapeutic use*; D014947:Wounds and Injuries / Q000188:drug therapy
D011994:Recombinant Proteins; D015942:Factor VIIa