The Use of Recombinant Factor VIIa in Surgical Bleeding in Nonhemophiliac Patients

Abstract

SUMMARYHemorrhage due to elective or emergency surgery results in significant patient morbidity and mortality and consumption of scarce transfusion resources. Recombinant factor VIIa (rFVIIa) has been proposed as a universal hemostatic agent which may be beneficial in reducing blood loss and in treating unexpected massive hemorrhage in surgical patients. In elective surgery, a small number of randomized studies have shown a limited benefit for rFVIIa in the reduction of transfusion requirements. In massive hemorrhage associated with surgery, two case series and a growing number of case reports suggest that rFVIIa is successful as salvage therapy. However, a number of questions remain regarding the optimal dose, the true rate of thromboembolic complications and the overall survival and cost benefit when rFVIIa is used for this indication. In this review, the role of rFVIIa in managing blood loss in surgical patients is assessed in the light of current evidence.