title: Recombinant activated factor VIIa to treat refractory lower gastrointestinal hemorrhage in a patient with recently implanted mechanical valve: a case report.
abstract: BACKGROUND
  Bleeding is a common complication after cardiac surgery. However, lower gastrointestinal bleeding is not usually associated with this type of surgery.
  
  
  METHODS
  A 50-year-old man with a history of aortic regurgitation underwent elective mechanical valve replacement under cardiopulmonary bypass. He experienced a complicated intraoperative course involving unexplained cardiac arrest following induction of anesthesia. He also developed two episodes of massive lower gastrointestinal bleeding secondary to mucosal ischemia while convalescing in the cardiothoracic surgery intensive care unit. After unsuccessful attempts to control the bleeding, exhaustion of blood products, and consideration of the high risk of mortality associated with surgery and the possibility of early- and long-term surgical complications, the decision was made to administer two successive doses of recombinant activated factor VII at 60 mcg/kg. Hemostasis was achieved without adverse systemic or valvular effects.
  
  
  CONCLUSIONS
  A favorable outcome was achieved after administration of recombinant activated factor VII, which controlled the patient's severe lower gastrointestinal bleeding. This outcome suggests the need to raise awareness about the use of this drug in dire circumstances when other conventional measures fail or are unsuitable.
authors.affiliation: Department of Cardiothoracic Surgery/Cardiac Anaesthesia & ICU Section, Heart Hospital, Hamad Medical Corporation, Doha PO: 3050 Doha, Qatar. a_s_omar@yahoo.com.
authors.forename: Amr S
authors.initials: AS
authors.lastname: Omar
authors.forename: Suraj
authors.initials: S
authors.lastname: Sudarsanan
authors.forename: Hesham
authors.initials: H
authors.lastname: Ewila
authors.forename: Ali
authors.initials: A
authors.lastname: Kindawi
mesh_terms: D015942:Factor VIIa / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use
chemical_list: D011994:Recombinant Proteins; D015942:Factor VIIa