title: Recombinant Activated Factor VII Significantly Reduces Transfusion Requirements in Cardiothoracic Surgery.
abstract: BACKGROUND
  The off-label use of recombinant activated factor VII (rFVIIa) for intractable bleeding is associated with a risk of thrombotic events. The objective of this study was to evaluate the incidence and predictors of rFVIIa-related thrombotic events and its efficacy in the reduction of transfusion requirements during various surgeries.
  
  
  METHODS
  Ninety-two cases received rFVIIa for uncontrollable bleeding despite medical and surgical hemostasis. The incidence and risk factors of thrombotic events were analyzed. Blood products transfused in the 24 h before and after rFVIIa injection were calculated. Subgroup analysis was performed to see which types of surgeries benefited most from rFVIIa.
  
  
  RESULTS
  The main indication for rFVIIa administration was uncontrollable bleeding during cardiothoracic surgery followed by coagulopathy due to liver failure followed by neurosurgical procedures. Requirements of blood products after rFVIIa decreased significantly by 45 % (p = 0.012), 52 % (p = 0.0001), and 75 % (p = 0.0001) for red blood cells, plasma, and cryoprecipitate, respectively. Subgroup analysis showed that cardiothoracic surgery was the sole group that benefited from rFVIIa with a reduction in transfusion of red blood cells (p = 0.013), plasma (p = 0.0001), and cryoprecipitate (p = 0.0001). Thrombotic events occurred in 9.8 % of the cases mostly on the arterial side (89 %) and have not contributed to mortality.
  
  
  CONCLUSIONS
  rFVIIa can significantly reduce transfusion requirements when given for intractable bleeding during cardiothoracic surgery at the expense of thrombotic events in approximately one tenth of the cases. Further prospective studies are necessary to study if this effect of rFVIIa is translated to a favorable outcome.
authors: Internal Medicine Department, Mercy Medical Center, 1410 N. Fourth Street, Clinton, IA, 52732, USA, hesham.omar@apogeephysicians.com.
authors: Hesham R
authors: HR
authors: Omar
authors: Garrett
authors: G
authors: Enten
authors: Rachel
authors: R
authors: Karlnoski
authors: Yiu-Hei
authors: YH
authors: Ching
authors: Devanand
authors: D
authors: Mangar
authors: Enrico M
authors: EM
authors: Camporesi
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods; D015942:Factor VIIa / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D065227:Transfusion Reaction
chemical_list: D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa