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Anesth Analg 2006;102:1320-1326
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000209023.96418.e5

CARDIOVASCULAR ANESTHESIA

Small-Dose Recombinant Activated Factor VII (NovoSeven®) in Cardiac Surgery

Stefano Romagnoli, MD, Sergio Bevilacqua, MD*, Sandro Gelsomino, MD{dagger}, Silvia Pradella, MD, Lorenzo Ghilli, MD{ddagger}, Carlo Rostagno, MD{ddagger}, Gian Franco Gensini, MD, and Carlo Sorbara, MD

*Department of Cardiac Surgery; Careggi Hospital, Florence, Italy; {dagger}Department of Radiology; University of Florence, Florence, Italy; {ddagger}Department of Internal Medicine and Cardiology; University of Florence, Florence, Italy.

Address correspondence and reprint requests to Stefano Romagnoli, MD, Cardiac Surgery Intensive Care, Careggi Hospital, Viale Morgagni 85, 50134, Florence, Italy. Address e-mail to romagnoliste{at}tiscali.it.

Recombinant activated factor VII (rFVIIa) has been used at different doses in cardiac surgery patients. We tested the efficacy of small-dose rFVIIa in patients with intractable bleeding after cardiac surgery. The study group comprised 15 cardiac surgery patients with intractable bleeding treated with small-dose (1.2 mg) rFVIIa as a slow IV bolus at the end of complete step-by step transfusion protocol. Fifteen matched patients undergoing the same transfusion protocol in the pre-rFVIIa era represented the control group. Blood loss at the end of the transfusion protocol was a primary outcome. Median, 25th–75th 24-h blood loss percentiles were 1685 (1590–1770) mL versus 3170 (2700–3850) mL in study group and controls, respectively (P = 0.0004). Transfused red blood cells, fresh-frozen plasma, and platelets in the study group and controls were as follows: 7 (4–8) U versus 18 (12–21) U (P = 0.001); 7.5 (6–11) U versus 11 (9–15) U (P = 0.003); 0 (0–4) U versus 9 (6–13) U (P = 0.001). In addition, significant improvements of prothrombin time (P = 0.015), international normalized ratio (P = 0.006), activated partial prothrombin time (P = 0.01), and platelet count (P = 0.003) were detected in the study group versus controls. Finally, patients receiving rFVIIa showed a reduced intensive care unit length of stay ({chi}2 = 15.9, P = 0.0001) and had infrequent surgical re-exploration ({chi}2 = 16.2,P < 0.0001). Small-dose rFVIIa showed satisfactory results in cardiac patients with intractable bleeding. Further randomized studies are necessary to confirm our findings.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.