Role of factor VII in correcting dilutional coagulopathy and reducing re-operations for bleeding following non-traumatic major gastrointestinal and abdominal surgery.
OBJECTIVE
The objective of this study is to evaluate the effectiveness of rfVIIa in reducing blood product requirements and re-operation for postoperative bleeding after major abdominal surgery.


BACKGROUND
Hemorrhage is a significant complication after major gastrointestinal and abdominal surgery. Clinically significant bleeding can lead to shock, transfusion of blood products, and re-operation. Recent reports suggest that activated rfVIIa may be effective in correcting coagulopathy and decreasing the need for re-operation.


METHODS
This study was a retrospective review over a 4-year period of 17 consecutive bleeding postoperative patients who received rfVIIa to control hemorrhage and avoid re-operation. Outcome measures were blood and clotting factor transfusions, deaths, thromboembolic complications, and number of re-operations for bleeding.


RESULTS
Seventeen patients with postoperative hemorrhage following major abdominal gastrointestinal surgery (nine pancreas, four sarcoma, two gastric, one carcinoid, and one fistula) were treated with rfVIIa. In these 17 patients, rfVIIa was administered for 18 episodes of bleeding (dose 2,400-9,600 mcg, 29.8-100.8 mcg/kg). Transfusion requirement of pRBC and FFP were each significantly less than pre-rfVIIa. Out of the 18 episodes, bleeding was controlled in 17 (94%) without surgery, and only one patient returned to the operating room for hemorrhage. There were no deaths and two thrombotic complications. Coagulopathy was corrected by rfVIIa from 1.37 to 0.96 (p < 0.0001).


CONCLUSIONS
Use of rfVIIa in resuscitation for hemorrhage after non-traumatic major abdominal and gastrointestinal surgery can correct dilutional coagulopathy, reducing blood product requirements and need for re-operation.
Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Thomas C
TC
Tsai
James H
JH
Rosing
Jeffrey A
JA
Norton
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001778:Blood Coagulation Disorders / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005167:Factor VII / Q000627:therapeutic use*; D005767:Gastrointestinal Diseases / Q000601:surgery*; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D011994:Recombinant Proteins; D012086:Reoperation / Q000706:statistics & numerical data*
D011994:Recombinant Proteins; D005167:Factor VII