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Original Articles: Pediatric Cardiac

Thrombotic Risk of Recombinant Factor Seven in Pediatric Cardiac Surgery: A Single Institution Experience

^a Division of Critical Care, Nationwide Children's Hospital, Columbus, Ohio
^g Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, Ohio
^b Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio
^d The Heart Center, Nationwide Children's Hospital, Columbus, Ohio
ⁱ Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
^c Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio
^e Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio
^h Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
^f Center for Biostatistics, The Ohio State University, Columbus, Ohio

Accepted for publication November 9, 2009.

^_* Address correspondence to Dr Kerlin, 700 Children's Dr, ED 583A, Columbus, OH 43205 (Email: bryce.kerlin{at}nationwidechildrens.org).

Background: Recombinant activated factor seven (rFVIIa) is increasingly being used as a hemostatic adjunct in pediatric cardiac surgery. We evaluated the thrombotic safety profile of rFVIIa in pediatric congenital heart disease (CHD) surgery.

Methods: This was a retrospective matched case-control study over six years at a single institution. Patients who received rFVIIa after CHD surgery were matched to controls based on age, diagnosis, and procedure. We compared thrombosis, hemorrhage, transfusions, length of stay, and repeat procedures between groups.

Results: Twenty-five patients received rFVIIa (mean dose: 70 mcg/kg); 50 controls were matched. There was no significant difference in the rate of thrombosis between patients who received rFVIIa and controls (8% vs 4%). After rFVIIa, there was a significant reduction in transfusion volume (median 77.1 mL/kg vs 14.6 mL/kg; p < 0.001) as well as a significant decrease in hemorrhagic chest tube output (8.3 ± 1.6 mL/kg/hour vs 1.4 ± 0.3 mL/kg/hour; mean ± standard error of the mean; p < 0.001). No difference was seen in intensive care unit or hospital length of stay or mortality between patients receiving rFVIIa and controls.

Conclusions: The rFVIIa therapy did not increase thrombotic complications when used as rescue therapy after CHD surgery but did appear to decrease bleeding complications in this small cohort.

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Invited Commentary

Aryeh Shander and Mazyar Javidroozi
Ann. Thorac. Surg. 2010 89: 576-577. [Extract] [Full Text] [PDF]

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				A. Shander and M. Javidroozi Invited Commentary Ann. Thorac. Surg., February 1, 2010; 89(2): 576 - 577. [Full Text] [PDF]