Опыт применения рекомбинантного активированного фактора свертывания VII в лечении массивных акушерских кровотечений

Abstract

This article presents the results of a retrospective observational study on the use of recombinant activated coagulation factor VII (Eptacog alfa [activated], Coagil-VII) to evaluate its efficacy and safety in the treatment of massive obstetric hemorrhage (MOH) in 30 women with volume of circulating blood loss over 25%; 90% of women delivered by cesarean section, and 10% of women delivered by vaginal birth. The efficacy and safety of Coagil-VII as a hemostatic agent in intensive therapy for MOH were evaluated using clinical, laboratory and statistical research methods. The administration of Eptacog alfa [activated] (Coagil-VII) helped to significantly reduce the volume of blood loss, duration, time and rate of bleeding, and the amount of blood component transfusion. The total dose of the drug was 3.68 mg. The analysis of laboratory parameters (hemogram, blood biochemistry tests) in patients of the study group with MOH did not reveal any negative effect of Coagil-VII according to the parameters. The results of the hemostatic system assessment showed that after administration of Coagil-VII there was an increase in blood coagulation potential, as evidenced by a decrease in International Normalized Ratio, shortened prothrombin and thrombin time, activated partial thromboplastin time. All parameters were within the reference range, without increasing the risk of thrombotic complications. No thrombotic complications in the early and late postoperative/postpartum period were detected in any patient. Hysterectomy in this study group was performed in 7 (23.3%) patients; the uterus was preserved in 23 (76.7%) women with MOH. The use of modern hemostatic drug Coagil-VII in the complex treatment of MOH under the control of clinical laboratory testing helped to stop (in 86.6% of women) or reduce the intensity of hemorrhage (in 13.3% of patients), reduce the amount of transfused blood components, improve the patients’ condition without thrombotic complications, reduce possible complications associated with transfusions and the cost of therapy, and implement organ preservation tactics in 76.7% of women. Key words: pregnancy, safety, massive hemorrhage, patient blood management, fertility, efficacy