Correction of a coagulopathy using recombinant factor VII before removal of an intra-aortic balloon pump

Abstract

IN PATIENTS with refractory cardiogenic shock, cardiovascular support with intra-aortic balloon counterpulsation can be life-saving. Specific morbidity may occur, however, related to the placement, use, and removal of these devices. Low levels of anticoagulation are frequently instituted during use of the intra-aortic balloon pump (IABP) to prevent thromboembolic complications. Before removal, however, normalization of coagulation parameters may decrease the potential for bleeding complications. Correction of coagulation may require only discontinuation of heparin administration. In critically ill patients, other factors, such as multisystem organ failure with hepatic dysfunction and associated disseminated intravascular coagulation (DIC), may be present. In this setting, it is generally feasible to correct the coagulation defect with blood products, including platelets, fresh frozen plasma (FFP), and cryoprecipitate. The authors present the case of a 19-year-old woman who suffered cardiogenic shock after an intraoperative cardiac arrest, who was supported with an IABP. Ongoing hepatic dysfunction and DIC resulted in a coagulopathy that was not responsive to the administration of FFP. The administration of recombinant factor VIIa (NovoSeven; Novo Nordisk, Princeton, NJ) normalized coagulation function.