Recombinant activated factor VII in the management of life-threatening bleeding in cardiac surgery

• Published in: European journal of cardio-thoracic surgery 2005-08, Vol.28 (2), p.254-258
• Main Authors: Hyllner, Monica, Houltz, Erik, Jeppsson, Anders
• Format: Article
• Language: English
• Subjects: 80 and over; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Blood Loss; Blood Loss, Surgical - prevention & control; Cardiac surgery; Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - mortality; Cardiac Surgical Procedures/methods/mortality; Cardiac Tamponade - prevention & control; Cardiology. Vascular system; Drug Administration Schedule; Factor VII - administration & dosage; Factor VIIa; Female; Humans; Injections; Injections, Intravenous; Intravenous; Kirurgi; Life-threatening bleeding; Male; Medical sciences; Middle Aged; Pneumology; Postoperative Hemorrhage - prevention & control; Recombinant activated factor VII; Recombinant Proteins - administration & dosage; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Surgical/prevention & control
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2005.04.021

Objective: Massive perioperative bleeding is a potential complication of cardiac surgery, and may persist despite conventional interventions. RFVIIa is being increasingly used as additional therapy, and the aim of the present study was to describe our experience with rFVIIa in the management of life-threatening bleeding in adult cardiac surgery. Methods: Retrospective chart review of 24 patients undergoing a variety of cardiac procedures was performed at Sahlgrenska University Hospital between January and August 2004. The patients developed life-threatening bleeding during or after surgery despite conventional medical therapy and transfusion of blood products, and received rFVIIa as additional therapy. Results: RFVIIa was administered as a median bolus dose of 60 μg/kg. Nineteen patients received one dose of rFVIIa; the bleeding stopped or decreased in 18 of them. Five patients received repeated doses of rFVIIa. Fifteen patients were reexplored due to massive postoperative bleeding or cardiac tamponade and a surgical source of bleeding was identified in six of these patients. A statistically significant reduction in chest drain losses after administration of rFVIIa was demonstrated. No adverse reactions were noted. Conclusions: RFVIIa was successfully used as an additional therapy both during and after cardiac surgery, when bleeding was refractory to conventional methods. Bleeding stopped eventually in all patients and none of the patients exsanguinated.