Low Dose Factor Eight Inhibitor Bypassing Activity (FEIBA) for Incessant Bleeding in Pediatric Patients on Mechanical Circulatory Support (MCS)

Abstract

Purpose The institution of mechanical circulatory support is often complicated by incessant bleeding as a result of pre-existing coagulopathy or the use of anticoagulation. The use of pro-coagulant factors in these cases carries a high risk for thrombosis or pump malfunction. The pro-coagulant FEIBA has been used for refractory bleeding in cases of factor deficiency, however its use in pediatric mechanical support patients has not been reported. Methods and Materials Retrospective review of FEIBA use in our pediatric mechanical circulatory program between June 2010 and Nov 2012. Results Eleven patients (weight 2.4 to 72 kg) on MCS received low dose FEIBA for uncontrolled postoperative bleeding. Three patients were placed on Heartmate 2® left ventricular assist device, two patients on right ventricular assist device after heart transplant (Biomedicus ® and Revolution ® ), three patients on the Berlin Heart ® ventricular assist device, and three patients on extracorporeal membrane circulatory support after congenital heart surgery. Ages ranged from 7 days to 16 years. Six patients received a single low dose (approximately 10 units/kg), three patients received two low doses, and two patients received greater than two low doses. Blood product utilization and chest tube output were decreased significantly following administration of FEIBA in all patients, although one patient required chest re-exploration. There were no thrombotic events or device malfunctions. There were three deaths unrelated to FEIBA administration. Conclusions Low dose FEIBA administration is effective in controlling bleeding in pediatric MCS patients. In appropriate situations, it can be used safely with a low adverse event rate.