Effect of recombinant activated factor VII in critical bleeding: clinical experience of a single center.
Recombinant activated factor VII (rFVIIa) has been successfully used ''off-label'' in patients with refractory life-threatening hemorrhage. Intravenous rFVIIa was given to 31 patients unresponsive to standard therapy with blood products and surgical reexploration, who were bleeding due to trauma, surgery, organ transplantation, liver cirrhosis, ruptured uterus. We recorded their coagulation and hematologic profiles, acid-base balance, blood loss, number of red blood cells (RBC), plasma and platelet transfusions, complications, and survival. rFVIIa (mean dose 132.2 +/- 56.3 microg/kg) effectively contained the hemorrhage in 28/31 (90.3%) cases, with a mean reduction in blood loss from 12.4 +/- 10.2 to 2.7 +/- 2.2 L (P < .0001). The need for RBC, platelet, and plasma transfusion decreased significantly after rFVIIa, with a consequent significant improvement in clotting of test hematocrit, pH, and bicarbonates. Four patients had adverse events potentially related to rFVIIa. The survival rates after 1 and 30 days were 48.4% and 29.1%, respectively.
Sartori
Maria Teresa
MT
Second Chair Internal Medicine, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. mtsart@unipd.it
Imbergamo
Silvia
S
Zanon
Ezio
E
Bonaccorso
Giuseppina
G
Pittoni
Giovanni
G
Feltracco
Paolo
P
Ori
Carlo
C
Pagnan
Antonio
A
Cella
Giuseppe
G
D000328:Adult; D000368:Aged; D001780:Blood Coagulation Tests; D016913:Blood Component Transfusion; D015942:Factor VIIa / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006403:Hematologic Tests; D006454:Hemoglobins / Q000032:analysis; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D015996:Survival Rate; D016896:Treatment Outcome
D006454:Hemoglobins; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa