title: Prophylactic activated recombinant factor VII in liver resection and liver transplantation: systematic review and meta-analysis.
abstract: OBJECTIVE
  Intraoperative blood loss is a frequent complication of hepatic resection and orthotopic liver transplantation. Recombinant activated coagulation factor VII (rFVIIa) is a coagulation protein that induces hemostasis by directly activating factor X. There is no clear information about the prophylactic value of rFVIIa in hepatobiliary surgery, specifically in liver resection and orthotopic liver transplantation. The aim of this study was to assess the effect of rFVIIa prophylaxis to prevent mortality and bleeding resulting from hepatobiliary surgery.
  
  
  METHODS
  Relevant randomized trials were identified by searching The Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index. Randomized clinical trials comparing different rFVIIa prophylactic schemas against placebo or no intervention to prevent bleeding in hepatobiliary surgery were included. Adults undergoing liver resection, partial hepatectomy, or orthotopic liver transplantation were included. Dichotomous data were analyzed calculating odds ratios (ORs) and 95% confidence intervals (CIs). Continuous data were analyzed calculating mean differences (MD) and 95% CIs.
  
  
  RESULTS
  Four randomized controlled trials were included. There were no significant differences between rFVIIa and placebo for mortality (OR 0.96; 95% CI 0.35-2.62), red blood cell units (MD 0.32; 95% CI -0.08-0.72) or adverse events (OR 1.55; 95% CI 0.97-2.49).
  
  
  CONCLUSIONS
  The available information is limited, precluding the ability to draw conclusions regarding bleeding prophylaxis in hepatobiliary surgery using rFVIIa. Although an apparent lack of effect was observed in all outcomes studied, further research is needed.
authors.affiliation: Obesity and Digestive Diseases Unit, Medica Sur Clinic and Foundation, Mexico City, Mexico. khavez@gmail.com
authors.forename: Norberto C
authors.initials: NC
authors.lastname: Chavez-Tapia
authors.forename: Roberto
authors.initials: R
authors.lastname: Alfaro-Lara
authors.forename: Felix
authors.initials: F
authors.lastname: Tellez-Avila
authors.forename: Tonatiuh
authors.initials: T
authors.lastname: Barrientos-Gutiérrez
authors.forename: Octavio
authors.initials: O
authors.lastname: González-Chon
authors.forename: Nahum
authors.initials: N
authors.lastname: Mendez-Sanchez
authors.forename: Misael
authors.initials: M
authors.lastname: Uribe
mesh_terms: D016063:Blood Loss, Surgical / Q000401:mortality / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D015942:Factor VIIa / Q000627:therapeutic use*; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D017594:Publication Bias; D011994:Recombinant Proteins / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa