title: Use of recombinant activated Factor VII for refractory after lung transplant bleeding as an effective strategy to restrict blood transfusion and associated complications.
abstract: BACKGROUND
  Recombinant activated factor VIIa (rFVIIa) has been increasingly used to stop massive bleeding after cardiothoracic surgical procedures. However, the risk : benefit profile of such a potent hemostatic agent remains unclear in the postsurgical patient, and the cost benefit is even less clear. In patients after lung transplantation, volume of blood transfused is of major concern, and all attempts are made to minimize large blood transfusions in this cohort. We report our experience with rFVIIa in patients with refractory bleeding after lung transplant surgery.
  
  
  METHODS
  All lung transplant patients who underwent single- or double-lung transplantation who received rFVIIa in the 5-year period, from January 2005 to June 2011, were included. A total of 15 patients were identified from a total of 95 lung transplant cases operated during this study period. Patient demographics, intra- and postoperative records were reviewed to assess the efficacy and safety of rFVIIa treatment.
  
  
  RESULTS
  Patients with major bleeding treated with rFVIIa showed improved hemostasis with rapid normalization of coagulation variables. rFVIIa treatment was not associated with an increase in mechanical ventilation time, length of intensive care unit stay, or hospital stay compared to other lung transplant patients. In addition, the use of rFVIIa was associated with reduction in transfusion requirements of red blood cells, fresh-frozen plasma, and platelets (all p < 0.001). No definite thromboembolic-related event was recorded in our cohort.
  
  
  CONCLUSIONS
  These data demonstrate that rFVIIa was associated with reduced blood loss, improvement of coagulation variables, and decreased need for transfusions. This reduction in losses led to a reduced requirement for blood transfusion, which may translate to a decrease in transfusion-related complications. Further investigation is needed to determine rFVIIa's safety and its efficacy in improving postoperative morbidity and mortality specifically in the field of post-lung transplantation surgery.
authors: John McCarthy Intensive Care Unit, the Department of Cardiothoracic Surgery, and the Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia. balu_bhaskar@health.qld.gov.au
authors: Balu
authors: B
authors: Bhaskar
authors: Marc
authors: M
authors: Zeigenfuss
authors: Jivesh
authors: J
authors: Choudhary
authors: John F
authors: JF
authors: Fraser
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D016913:Blood Component Transfusion / Q000706:statistics & numerical data; D004334:Drug Administration Schedule; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000097:blood / Q000188:drug therapy* / Q000628:therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000601:surgery; D011656:Pulmonary Emphysema / Q000601:surgery; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006490:Hemostatics; D011994:Recombinant Proteins; D015942:Factor VIIa