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

Disseminated Intravascular Coagulation

The use of rFVIIa was reported in a pregnant woman with DIC in whom severe intra-abdominal bleeding developed after cesarean section. rFVIIa was given after an initial attempt to control bleeding with FFP, fibrinogen, platelets, and surgery. Bleeding was controlled rapidly, with resolution of the coagulopathy.[95]

Another report on the use of rFVIIa in 3 children with bleeding secondary to liver failure and DIC states that bleeding was controlled effectively and the PT was shortened.[3] Cases 1 and 2 (girls aged 3 and 6 years, respectively) were diagnosed with dengue hemorrhagic fever and prolonged shock. Case 3 (a boy aged 9 months) underwent left lobe hepatectomy for hepatoblastoma, during which 60% of his liver was removed. This case was complicated by myoglobinuria, liver and renal impairment, and early DIC. All 3 patients had active bleeding. The children in cases 1 and 2 received rFVIIa combined with other blood component replacements, while the boy in case 3 received rFVIIa as the only hemostatic agent. A bolus of 40 to 180 µg/kg of body weight was administered, followed by 16.5 to 33 µg/kg of body weight per hour in a continuous infusion. As a result, bleeding was controlled, the PT was shortened, and the factor VII clotting activity was increased significantly.

In another case report, rFVIIa effectively controlled bleeding associated with severe necrotizing pancreatitis.[117]

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