The utility of thromboelastography for guiding recombinant activated factor VII therapy for refractory hemorrhage after cardiac surgery.
OBJECTIVE
Recombinant activated factor VII (rFVIIa) is being increasingly used in cardiac surgical patients with refractory hemorrhage. In this study, the authors assessed the ability of thromboelastography (TEG) in guiding rFVIIa therapy in this setting.


METHODS
Retrospective study.


METHODS
Tertiary care university hospital.


METHODS
Thirty-eight consecutive patients who received rFVIIa for refractory hemorrhage after cardiac surgery and had a complete coagulation profile including TEG within 30 minutes before and after rFVIIa.


METHODS
Standard coagulation (prothrombin time, partial thromboplastin time, platelet number, and fibrinogen) and TEG measurements (r time, k time, alpha angle, and maximum amplitude) before and after rFVIIa therapy were compared between responders and nonresponders (determined retrospectively based on clinical records).


RESULTS
Twenty-eight patients (74%) were classified as responders. There were no consistent changes in standard coagulation and TEG measurements before and after rFVIIa therapy. The number of abnormalities in pretreatment coagulation tests was related to response rates; odds of response were 11-fold (95% confidence interval [CI]) and 33-fold (95% CI) greater among patients with 0 or 1 abnormality in standard coagulation tests and TEG measures, respectively, than those with 2 or more abnormalities.


CONCLUSIONS
TEG may be a useful tool for predicting response to rFVIIa in the setting of refractory hemorrhage after cardiac surgery.
Wasowicz
Marcin
M
Department of Anesthesia, Toronto General Hospital, Toronto, Ontario, Canada. marcin.wasowicz@uhn.on.ca
Meineri
Massimiliano
M
McCluskey
Stuart M
SM
Mitsakakis
Nicholas
N
Karkouti
Keyvan
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001778:Blood Coagulation Disorders / Q000175:diagnosis*; D001780:Blood Coagulation Tests; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003029:Coagulants / Q000627:therapeutic use*; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000188:drug therapy* / Q000209:etiology; D011994:Recombinant Proteins / Q000627:therapeutic use; D013916:Thrombelastography / Q000187:drug effects* / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
D003029:Coagulants; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa