Fatal outcome of recombinant factor VIIa in heart transplantation with extracorporeal membrane oxygenation.
Recombinant activated factor VII (rFVIIa) has been approved for treatment of bleeding episodes in patients with hemophilia and in nonhemophilia patients with acquired antibodies against factor VIII or IX. The application of rFVIIa in nonapproved settings, as in cardiac surgery, has not been established. It raises concerns regarding its safety. We used rFVIIa in a patient with excessive nonsurgical bleeding on extracorporeal membrane oxygenation, which was established for early graft failure after heart transplantation and after 3 months of biventricular assist device support. After rFVIIa administration, cardiac thrombosis developed and caused the patient's death.
Syburra
Thomas
T
Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland; Clinic for Cardiac Surgery, City Hospital Triemli, Zurich, Switzerland.
Lachat
Mario
M
Genoni
Michele
M
Wilhelm
Markus J
MJ
D001344:Autopsy; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003131:Combined Modality Therapy; D018450:Disease Progression; D015199:Extracorporeal Membrane Oxygenation; D015942:Factor VIIa / Q000008:administration & dosage / Q000009:adverse effects*; D017809:Fatal Outcome; D006084:Graft Rejection; D006333:Heart Failure / Q000175:diagnosis / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects* / Q000379:methods; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D018570:Risk Assessment; D014850:Waiting Lists
D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa