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CARDIOVASCULAR ANESTHESIOLOGY

Thrombelastography-Guided Factor VIIa Therapy in a Surgical Patient with Severe Hemophilia and Factor VIII Inhibitor

Evan G. Pivalizza, MB ChB, FFASA^*, and Miguel A. Escobar, MD

From the Departments of *Anesthesiology, Medicine and Pediatrics, University of Texas Health Science Center, and Department of Hematology and the Gulf States Hemophilia & Thrombophilia Center, Houston, Texas.

Address correspondence and reprint requests to Evan G. Pivalizza, MB ChB, FFASA, Department of Anesthesiology, University of Texas Health Science Center, Houston, MSB 5.020, 6431 Fannin St., Houston, TX 77030. Address e-mail to Evan.G.Pivalizza{at}uth.tmc.edu.

Abstract

A patient with hemophilia and factor VIII inhibitors required urgent evacuation of a spinal cord hematoma. Two large doses of recombinant factorVIIa (200 µg/kg followed by 300 µg/kg) were required for hemostasis. Traditional and rotational thrombelastography were used to guide dose and timing of rFVIIa therapy. With the limitations of prothrombin and partial thromboplastin times as perioperative monitors of rFVIIa efficacy, this description of thrombelastography supports reports of in vitro use, and may be helpful when large perioperative doses of rFVIIa are required.