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Ann Thorac Surg 2006;81:875-879
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Recombinant Activated Factor VII: Treating Postoperative Hemorrhage in Cardiac Surgery

Conrad V. Bishop, MBBS a , William E.P. Renwick, MBBS b , Chris Hogan, MBBS b , Michael Haeusler, BS b , Annabel Tuckfield, MBBS b , James Tatoulis, MS, FRACS a , *

a Department of Cardiothoracic Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
b Department of Hematology, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia

Accepted for publication September 1, 2005.

* Address correspondence to Professor Tatoulis, Suite 28, Private Medical Centre, Royal Melbourne Hospital, Victoria 3050, Australia (Email: james.tatoulis{at}mh.org.au).

BACKGROUND: The purpose of this study is to review the effect of recombinant activated factor VII (rFVIIa) as rescue therapy in continuing severe postoperative hemorrhage, despite conventional measures in a series of cardiac patients at our institution.

METHODS: A series of all patients who received rFVIIa as rescue therapy for uncontrollable postoperative hemorrhage after cardiac surgery over a 2-year period was analyzed. We assessed and compared the use of blood products, coagulation indicators (international normalized ratio [INR], activated partial thromboplastin [APTT], and fibrinogen), and platelet levels immediately before and after the rFVIIa was given.

RESULTS: Twelve patients received rFVIIa. Eight patients (75%) had thoracic aortic surgery. Bleeding stopped in all cases. Prior to the administration of rFVIIa, mean blood product usage was the following: fresh frozen plasma (FFP) 18.7 units (range, 10–40); packed cells 7.7U (range, 0–18); cryoprecipitate 19.5U (range, 8–32); and platelets 22.5U (range, 10–40). The mean coagulation results immediately prior to rFVIIa were the following: INR 2.0 (range, 1.3–8.5); APTT 60 seconds (range, 30–220); fibrinogen 3.2 gm/L (range, 1.6–6.4), and platelet count was 174,000 (range, 78,000–257,000). After rFVIIa administration the mean blood product usage was the following: FFP 0U (range, 0–2); red cells 0U (range, 0–1); cryoprecipitate 0 (range, 0); and platelets 0 (range, 0); p less than 0.0005. The mean INR was 0.9 (range, 0.7–1.5), p less than 0.001; mean APTT was 42 seconds (range, 30–87), mean fibrinogen was 3.1 (range, 1.7–4.5), and the mean platelet count was 170,000 (range, 93,000–289,000); p values not significant. There were no thrombotic complications, no cardiac ischemic events, and no deaths.

CONCLUSIONS: Our results support the use of rFVIIa as rescue therapy in severe, uncontrollable, nonsurgical, postoperative hemorrhage after cardiac surgery as efficacious and safe.




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