Thrombelastography-guided factor VIIa therapy in a surgical patient with severe hemophilia and factor VIII inhibitor.
A patient with hemophilia and factor VIII inhibitors required urgent evacuation of a spinal cord hematoma. Two large doses of recombinant factor VIIa (200 microg/kg followed by 300 microg/kg) were required for hemostasis. Traditional and rotational thrombelastography were used to guide dose and timing of rFVIIa therapy. With the limitations of prothrombin and partial thromboplastin times as perioperative monitors of rFVIIa efficacy, this description of thrombelastography supports reports of in vitro use, and may be helpful when large perioperative doses of rFVIIa are required.
Pivalizza
Evan G
EG
Department of Anesthesiology, University of Texas Health Science Center, Houston, MSB 5.020, 6431 Fannin St., Houston, TX 77030, USA. Evan.G.Pivalizza@uth.tmc.edu
Escobar
Miguel A
MA
D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005169:Factor VIII / Q000276:immunology*; D015942:Factor VIIa / Q000627:therapeutic use*; D006467:Hemophilia A / Q000097:blood / Q000150:complications / Q000276:immunology / Q000628:therapy*; D006801:Humans; D008297:Male; D011994:Recombinant Proteins / Q000627:therapeutic use; D013514:Surgical Procedures, Operative; D013916:Thrombelastography
D001323:Autoantibodies; D011994:Recombinant Proteins; D005169:Factor VIII; C103587:recombinant FVIIa; D015942:Factor VIIa