title: Impact on postoperative bleeding and cost of recombinant activated factor VII in patients undergoing heart transplantation.
abstract: BACKGROUND
  Cardiac transplantation can be complicated by refractory hemorrhage particularly in cases where explantation of a ventricular assist device is necessary. Recombinant activated factor VII (rFVIIa) has been used to treat refractory bleeding in cardiac surgery patients, but little information is available on its efficacy or cost in heart transplant patients.
  
  
  METHODS
  Patients who had orthotopic heart transplantation between January 2009 and December 2014 at a single center were reviewed. Postoperative bleeding and the total costs of hemostatic therapies were compared between patients who received rFVIIa and those who did not. Propensity scores were created and used to control for the likelihood of receiving rFVIIa in order to reduce bias in our risk estimates.
  
  
  RESULTS
  Seventy-six patients underwent heart transplantation during the study period. Twenty-one patients (27.6%) received rFVIIa for refractory intraoperative bleeding. There was no difference in postoperative red blood cell transfusion, chest tube output, or surgical re-exploration between patients who received rFVIIa and those who did not, even after adjusting with the propensity score (P = 0.94, P = 0.60, and P = 0.10, respectively). The total cost for hemostatic therapies was significantly higher in the rFVIIa group (median $10,819 vs. $1,985; P < 0.0001). Subgroup analysis of patients who underwent redo-sternotomy with left ventricular assist device explantation did not show any benefit for rFVIIa either.
  
  
  CONCLUSIONS
  In this relatively small cohort, rFVIIa use was not associated with decreased postoperative bleeding in patients undergoing heart transplantation; however, it led to significantly higher cost.
authors.affiliation: Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD 21201, USA.
authors.forename: Allison L
authors.initials: AL
authors.lastname: Hollis
authors.affiliation: Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD 21201, USA.
authors.forename: Ashleigh V
authors.initials: AV
authors.lastname: Lowery
authors.affiliation: Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD 21201, USA.
authors.forename: Mehrnaz
authors.initials: M
authors.lastname: Pajoumand
authors.affiliation: Department of Cardiothoracic Surgery, University of Maryland Medical Center, Baltimore, MD 21201, USA.
authors.forename: Si M
authors.initials: SM
authors.lastname: Pham
authors.affiliation: School of Pharmacy, University of Maryland Medical Center, Baltimore, MD 21201, USA.
authors.forename: Julia F
authors.initials: JF
authors.lastname: Slejko
authors.affiliation: Department of Anesthesiology, University of Maryland Medical Center, Baltimore, MD 21201, USA.
authors.forename: Kenichi A
authors.initials: KA
authors.lastname: Tanaka
authors.affiliation: Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD 21201, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Mazzeffi
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D003029:Coagulants / Q000191:economics* / Q000627:therapeutic use*; D015331:Cohort Studies; D015942:Factor VIIa / Q000191:economics* / Q000627:therapeutic use*; D005260:Female; D016027:Heart Transplantation; D006490:Hemostatics / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000188:drug therapy* / Q000191:economics; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003029:Coagulants; D006490:Hemostatics; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa