Recombinant activated factor VII (rFVIIa) for uncontrolled bleeding post cardiac surgery

Abstract

To review recombinant activated factor VII (rFVIIa) as rescue therapy in persistent severe hemorrhage in post cardiac surgical patients at our institution. A retrospective observational study. From 2004 till April 2010, all patients who received rFVIIa for bleeding of 3 ml/kg/h or more for two consecutive hours after cardiac surgery were included. Surgical bleeding management, patient temperature correction, blood products replacement, and coagulant drugs administration preceded the rFVIIa. The mean for chest tube drainage was significantly lower after the administration of rFVIIa compared to that before (1.2 ± 1.08 vs. 4.1 ± 2.3 ml/kg/h, P = 0.042). There was a significant decrease in the median of: aPTT (43.8 vs. 46.6 s, P = 0.027), ACT (128.9 vs. 131.7 s, P = 0.05), and INR (1.0 vs. 1.43, P = 0.001) after the administration of rFVIIa compared to that before. The median of fibrinogen level and the platelet count showed non-significant increase after the rFVIIa doses (2.57 vs. 2.43 gm/l, P = 0.34 and 106 vs. 101 X109/l, P = 0.27 respectively). Six patients (3.7%) needed re-exploration after the administration of rFVIIa. Five patients (3.2%) had thrombo-embolic complications. The small dose (40–50 mcg/kg) was comparable to high dose (⩾80 mcg/kg) of rFVIIa in terms of: mean chest tube bleeding within the first 4 h, blood products required in the first 24 h, re-exploration for bleeding or thrombotic complications. rFVIIa produced significant reduction in chest tube bleeding post cardiac surgery with reduction in the administration of blood products. Small dose rFVIIa can be considered effective for intractable bleeding after cardiac surgery.