title: Combination use of platelets and recombinant activated factor VII for increased hemostasis during acute type a dissection operations.
abstract: BACKGROUND
  Refractory blood loss is a common problem in surgeries for acute type A aortic dissections. Significant evidence has supported the benefit of using recombinant activated factor VII (rFVIIa) to control of intractable bleeding in patients after cardiac surgery. In this prospective clinical study, we present a novel method to achieve intraoperative hemostasis by using a combination of platelets and rFVIIa during operations for acute type A aortic dissections.
  
  
  METHODS
  Between May 2009 and August 2012, 71 patients with acute type A dissections who underwent emergency surgery were prospectively included and allocated to one of the following two intervention groups for hemostasis: 3 units platelets combined with 2.4 mg rFVIIa (n = 25), and conventional methods (n = 46).
  
  
  RESULTS
  The patients who received the combination of platelets and rFVIIa required fewer transfusions of red blood cells (6.2 ± 3.1 units vs 9.8 ± 2.8 units; p < 0.05), fresh frozen plasma (736.9 ± 178.3 ml vs 1264.3 ± 245.2 ml, p < 0.05), platelet concentrates (3 units vs 5.0 ± 1.8 units, p < 0.001), and cryoprecipitate (2.8 ± 0.9 units vs 8.2 ± 2.3 units, p < 0.05). These patients also required less time for sternal closure (76.9 ± 17.2 min vs 102.3 ± 10.7 min, p < 0.05) compared with the conventional therapy patients. There was no statistically significant difference in the incidence of serious adverse events between these two groups.
  
  
  CONCLUSIONS
  Using a combination of platelets and rFVIIa is an effective strategy for achieving hemostasis during acute type A dissection surgery. This hemostatic strategy does not appear to be associated with an increase in postoperative adverse events.
authors.forename: Wen
authors.initials: W
authors.lastname: Yan
authors.forename: Chengluan
authors.initials: C
authors.lastname: Xuan
authors.forename: Guojia
authors.initials: G
authors.lastname: Ma
authors.forename: Liang
authors.initials: L
authors.lastname: Zhang
authors.forename: Ning
authors.initials: N
authors.lastname: Dong
authors.forename: Zijian
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Cardiovascular Surgery, Second Hospital of Jilin University, Jilin University, Changchun 130041, Jilin, China. xu6mouse@163.com.
authors.forename: Rihao
authors.initials: R
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003131:Combined Modality Therapy; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa