title: Factor VII for excessive bleeding following congenital heart disease surgery.
abstract: Recombinant activated factor VII may be effective in patients with severe bleeding following congenital heart disease surgery requiring cardiopulmonary bypass. From August 2009 through June 2011, 13 patients (median age, 5 months) were given recombinant activated factor VII for severe bleeding after open heart surgery, preventing sternal closure 2 h after completion of cardiopulmonary bypass, or chest tube drainage >10 mL · kg(-1) · h(-1) for 2 h. The median dose was 75 μg · kg(-1). The response was positive if postoperative bleeding decreased, permitting sternal closure in the operating room, or if there was >50% decrease in chest tube drainage. The 3 patients who received factor VIIa in the operating room had successful sternal closure within 1 h. Of the 10 patients who received factor VIIa in the intensive care unit, drainage decreased to <50% in 1 h in 6 cases, and a second dose was required in 4. None required surgical reexploration. There were 4 deaths, none was related to bleeding. Nine patients were discharged (median hospital stay, 29 days) and were doing well after 3 months. There were no thrombotic complications. Recombinant activated factor VII may be an effective rescue therapy for severe postoperative hemorrhage.
authors.affiliation: Department of Pediatric Cardiology, The Madras Medical Mission, Chennai, India.
authors.forename: Deepak Kishinchand
authors.initials: DK
authors.lastname: Changlani
authors.forename: Vimalarani
authors.initials: V
authors.lastname: Devendaran
authors.forename: Udaya Charan
authors.initials: UC
authors.lastname: Murmu
authors.forename: Selvakumar
authors.initials: S
authors.lastname: Ganesan
authors.forename: Roy
authors.initials: R
authors.lastname: Varghese
authors.forename: Raghavannair Suresh
authors.initials: RS
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D015942:Factor VIIa / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019106:Postoperative Hemorrhage / Q000188:drug therapy* / Q000453:epidemiology; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
chemical_list: D011994:Recombinant Proteins; D015942:Factor VIIa