title: Coagulation factor VIIa (recombinant) in nonhemophilic patients requiring neurosurgery.
abstract: OBJECTIVE
  The clinical outcomes, safety, and use of resources associated with the administration of factor VIIa (recombinant) to nonhemophilic patients requiring neurosurgery were evaluated.
  
  
  METHODS
  An interdisciplinary group created guidelines for the pharmacy and therapeutics committee for the unlabeled use of factor VIIa (recombinant). Nonhemophilic patients were eligible to receive the agent without approval from the hematology-coagulation service if they had an intracranial hemorrhage (ICH), were undergoing an emergency neurosurgical procedure, and had coagulopathy. A standard single dose of 40 microg/kg was recommended for these patients. Data were prospectively collected between March 2004 and March 2006 for all neurological surgery patients receiving factor VIIa (recombinant).
  
  
  RESULTS
  A total of 92 nonhemophilic patients received single doses of factor VIIa (recombinant) under the guidelines during the two-year study period. The majority of patients had a baseline International Normalized Ratio (INR) of >2, underwent emergency neurosurgical procedures, and had an intracranial hemorrhage. All guideline criteria for indication and approval were followed for 48 patients. Eighty-seven patients received concomitant treatment for reversal of anticoagulation. A significant correction in the baseline INR after administration of factor VIIa (recombinant) was noted (p < 0.0001). Five patients experienced adverse events. Implementation of the guidelines decreased the annual cost of factor VIIa (recombinant) by 46%.
  
  
  CONCLUSIONS
  A protocol calling for administration of factor VIIa (recombinant) 40 microg/kg in nonhemophilic patients with coagulopathy and ICH led to a rapid and significant decrease in the INR, allowing for emergency surgical intervention. Few adverse events were detected in these patients, and none were deemed to be directly related to factor VIIa (recombinant).
authors.affiliation: Drug Use and Disease State Management (DUDSM) Program, Department of Pharmacy and Therapeutics, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15213, USA. culleycm@upmc.edu
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Culley
authors.forename: Susan
authors.initials: S
authors.lastname: Guttendorf
authors.forename: Megan
authors.initials: M
authors.lastname: Coldren
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Skledar
authors.forename: Paige R
authors.initials: PR
authors.lastname: Gross
authors.forename: Richard M
authors.initials: RM
authors.lastname: Spiro
authors.forename: Darrell J
authors.initials: DJ
authors.lastname: Triulzi
authors.forename: Margaret V
authors.initials: MV
authors.lastname: Ragni
mesh_terms: D000368:Aged; D001778:Blood Coagulation Disorders / Q000150:complications* / Q000188:drug therapy*; D015942:Factor VIIa / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D019934:International Normalized Ratio; D020300:Intracranial Hemorrhages / Q000188:drug therapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011446:Prospective Studies; D011994:Recombinant Proteins
chemical_list: D011994:Recombinant Proteins; D015942:Factor VIIa