Prophylactic use of NovoSeven in surgical procedures in a patient with coagulation disorders in the course of abdominal actinomycosis

Abstract

Recombinant activated factor VII (rVIIa – NovoSeven, Novo Nordisk Pharm, Denmark) is commonly used in the treatment of coagulation disorders. At present, numerous studies are being carried out with reference to expanding the indications for this drug, especially in preventing perioperative bleedings in patients at a high risk for bleeding as a result of various coagulation disorders such as hemophilia. The aim of this work was to assess the effectiveness of a prophylactic use of rVIIa in patients with complex coagulation disorders before surgery or invasiveprocedures. This paper presents a case report concerning a patient with abdominal actinomycosis hospitalized at the Intensive Care Unit (ICU), who developed peritonitis and severe coagulopathy of a complex etiology and required massive transfusions of blood products. During his 200-day hospitalization, initial treatment comprised invasive procedures without the preventive use of rVIIa; however, later on due to severe bleedings accompanying treatments, NovoSeven was administered as a preoperative prophylaxis. After treatment, blood loss related to invasive procedures and transfusion requirements were assessed and compared to no drug use during the invasive procedures as well as during prophylactic NovoSeven administration. Preoperative use of NovoSeven resulted in reducing significant perioperative bleedings; moreover, there was a decrease in the requirement for postoperative blood transfusions. Supplementation of morphotic blood elements and coagulation factors in the form of fresh frozen plasma and cryoprecipitate frequently does not result in obtaining the desired outcome of clinically effective hemostasis. The additional supply of rVIIa in such cases enables one to control bleeding. Preventive use of NovoSeven seems to be effective in reducing the frequency of perioperative bleedings that require blood products transfusions, particularly in patients with complex coagulopathy.