Recombinant factor VIIa as last-resort treatment of desperate haemorrhage

Acta Anaesthesiologica Scandinavica, 04/11/2012

Palmason R et al. – The majority of unselected consecutive patients receiving recombinant activated coagulation factor VII (rFVIIa) as last–resort treatment for desperate haemorrhage were considered to have immediate clinical response as well as reduced transfusion requirements and correction of coagulation parameters. An immediate clinical response to rFVIIa may possibly be predictive of survival.

Methods

  • Hospital charts of all consecutive patients treated with rFVIIa for desperate non-haemophilic bleeding over a 10-year period at the single institution administering rFVIIa were surveyed for treatment indications, clinical outcome, transfusion need and coagulation profiles.

Results

  • Fifty-five rFVIIa treatment occasions of desperate bleeding were identified in 54 patients (median age 54years).
  • A single rFVIIa dose was used in 86%, and haemorrhage was considered effectively contained by immediate clinical response on 81% of occasions.
  • Overall, 38 patients (71%) survived for over 30 days.
  • Two thromboembolic events occurred (3.6%).
  • The 24-h mortality in 45 rFVIIa immediate clinical responders and 10 non-responders was 2% and 50%, respectively (P=0.0004), and the 30-day mortality was 25% and 60%, respectively (P=0.05).
  • Blood product use decreased with rFVIIa (P<0.01) as did the prothrombin time (20.0-13.3s, P<0.0001).

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