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CARDIOVASCULAR ANESTHESIA

Successful Reversal of Deleterious Coagulopathy by Recombinant Factor VIIa

Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria

Address correspondence and reprint requests to Thorsten Haas, MD, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. Address e-mail to thorsten.haas{at}uibk.ac.at

Effective treatment of severe or uncontrolled bleeding is a challenge for physicians in the operating room and intensive care unit. However, even aggressive conventional therapy may ultimately fail in some patients. Administration of recombinant activated factor VII (rFVIIa) may be the only remaining therapeutic option to stop life-threatening coagulopathic bleeding. We here describe the clinical course of 5 patients exhibiting severe continuous bleeding that could not be stopped by surgical intervention and appropriate hemostatic management but resolved after a mean dose of 90 µg/kg of rFVIIa (range, 90–120 µg/kg). Four of the five patients recovered completely, and one patient died after developing sepsis in multiorgan failure. In all patients, bleeding from wound surfaces stopped within minutes of the administration of rFVIIa. Coagulation measurements improved, and transfusion requirements declined considerably. No adverse effects associated with rFVIIa were observed.

IMPLICATIONS: Recombinant activated factor VIIa (rFVIIa) proved to be a powerful therapeutic option for the management of life threatening bleeding caused by unresponsive coagulopathy. Roughly estimated, rFVIIa is as expensive as accepted conventional therapy but is also impressively effective in reversing persistent coagulopathy, even when traditional transfusion therapy fails.

This article has been cited by other articles:

				S. Schmid, B. Friesenecker, I. Lorenz, P. Innerhofer, J. Koscielny, C. Velik-Salchner, N. Mutz, and D. Fries Administration of Recombinant Activated Factor VII (NovoSeven) in Three Cases of Uncontrolled Bleeding Caused by Disseminated Intravascular Coagulopathy Clinical and Applied Thrombosis/Hemostasis, July 1, 2007; 13(3): 313 - 317. [Abstract] [PDF]