Thrombotic risk of recombinant factor seven in pediatric cardiac surgery: a single institution experience.
BACKGROUND
Recombinant activated factor seven (rFVIIa) is increasingly being used as a hemostatic adjunct in pediatric cardiac surgery. We evaluated the thrombotic safety profile of rFVIIa in pediatric congenital heart disease (CHD) surgery.


METHODS
This was a retrospective matched case-control study over six years at a single institution. Patients who received rFVIIa after CHD surgery were matched to controls based on age, diagnosis, and procedure. We compared thrombosis, hemorrhage, transfusions, length of stay, and repeat procedures between groups.


RESULTS
Twenty-five patients received rFVIIa (mean dose: 70 mcg/kg); 50 controls were matched. There was no significant difference in the rate of thrombosis between patients who received rFVIIa and controls (8% vs 4%). After rFVIIa, there was a significant reduction in transfusion volume (median 77.1 mL/kg vs 14.6 mL/kg; p < 0.001) as well as a significant decrease in hemorrhagic chest tube output (8.3 +/- 1.6 mL/kg/hour vs 1.4 +/- 0.3 mL/kg/hour; mean +/- standard error of the mean; p < 0.001). No difference was seen in intensive care unit or hospital length of stay or mortality between patients receiving rFVIIa and controls.


CONCLUSIONS
The rFVIIa therapy did not increase thrombotic complications when used as rescue therapy after CHD surgery but did appear to decrease bleeding complications in this small cohort.
Karsies
Todd J
TJ
Division of Critical Care, Nationwide Children's Hospital, Columbus, Ohio, USA.
Nicol
Kathleen K
KK
Galantowicz
Mark E
ME
Stephens
Julie A
JA
Kerlin
Bryce A
BA
D000293:Adolescent; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D015942:Factor VIIa / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery*; D006488:Hemostasis, Surgical; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000517:prevention & control; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D013927:Thrombosis / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis
D011994:Recombinant Proteins; D015942:Factor VIIa