Recombinant Factor VIIA in the Treatment of Bleeding

Madhu V. Midathada, MD; Paulette Mehta, MD; Milton Waner, MD; Louis M. Fink, MD

Disclosures

Am J Clin Pathol. 2004;121(1) 

In This Article

Discussion

There has been an increased use of rFVIIa in patients with severe bleeding. This review has attempted to reference most of the reports describing the use of rFVIIa in nonhemophiliac conditions, excluding those with acquired inhibitors of factor VIII or IX. There are questions about the indications for this therapy, and some want to use rFVIIa only after attempts to control hemorrhage with conventional factors and blood replacement have failed.

Some reports have described concurrent treatment with antifibrinolytic agents, and some have not. Most have used doses of approximately 90 µg/kg given as an intravenous bolus and have given a second treatment if bleeding persisted, but higher doses might be tolerated. Some reports have described the use of continuous infusion.

In many cases, the PT and aPTT have been shortened markedly after treatment with rFVIIa, and there are few reports of systemic thromboses. In cases in which the fibrinogen level or platelet count is low, it might be best to give these components before administering rFVIIa to optimize the hemostatic effect of the treatment. Recently, rFVIIa has been found to reduce the intraoperative blood loss during resection of congenital vascular lesions (M.W., oral communication, July 2003). At least 2 patients in this series would not have been able to undergo operation without rFVIIa.

Because some uses are in unusual and rare cases, there might never be enough cases to statistically evaluate the effectiveness of rFVIIa, and good clinical judgment will have to be used to determine when to use this agent and how to administer it. This is a new agent in our armamentarium for the treatment of acute hemorrhage.

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