Use of recombinant factor VIIa to correct the coagulation status of individuals with advanced liver disease prior to a percutaneous liver biopsy.
OBJECTIVE
Percutaneous liver biopsies are used to grade and stage liver disease and are also useful in monitoring the progress of liver disease over time as well as the response to medical therapies. The present study was undertaken to assess the effectiveness of recombinant factor VIIa as a means of transiently correcting the coagulopathy, enabling the safe performance of a percutaneous liver biopsy in patients in whom the use of fresh-frozen plasma is not possible without precipitating pulmonary edema or who have a treatment induced (iatrogenic) coagulopathy.


METHODS
The subjects of this report consisted of 18 consecutive individuals with advanced disease induced, and 15 with a therapeutic iatrogenic-induced, coagulopathy. All biopsies were performed by a single hepatologist. Before and 6 h after each biopsy, a prothrombin time and partial thromboplastin time was obtained from each subject. Mean values +/- the standard error of the mean were obtained using the independent samples T-test.


RESULTS
Recombinant factor VIIa had a marked effect in transiently correcting the mean prothrombin time in these subjects allowing for a safe complication free percutaneous biopsy in this high-risk group.


CONCLUSIONS
Recombinant factor VIIa could be used to obtain a clinically indicated liver biopsy in severely ill patients, who without this therapeutic agent, would either not be biopsied or, if biopsied, would require much longer hospitalization and the use of fresh-frozen plasma (with its risks of volume overload and infection).
Sajjad
Shabbar
S
St. Luke's Medical Center, Aurora Health Care, Milwaukee, WI 53215, USA.
Garcia
Moises
M
Malik
Ahmed
A
George
Magdalena M
MM
Van Thiel
David H
DH
D000925:Anticoagulants / Q000627:therapeutic use*; D001707:Biopsy, Needle / Q000009:adverse effects*; D001777:Blood Coagulation / Q000187:drug effects*; D016913:Blood Component Transfusion / Q000009:adverse effects; D003029:Coagulants / Q000627:therapeutic use*; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011517:Prothrombin Time; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D012720:Severity of Illness Index
D000925:Anticoagulants; D003029:Coagulants; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa