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Correspondence

Recombinant Activated Factor VII and Cardiac Surgery

Department of Anesthesiology and Intensive Care, Sapienza University of Rome, Viale del Policlinico 155, Rome, 00161 Italy

(Email: vincenzo.desantis{at}uniroma1.it).

To the Editor:

We appreciated the article by Bowman and colleagues [1]. The authors demonstrated that rescue therapy with recombinant human activated factor VII (rFVIIa) is effective in reducing transfusion requirements, correcting coagulopathy, and controlling of life-threatening bleeding in patients undergoing high-risk cardiovascular surgery. The majority of patients (94.4%) received a 90 µg/kg dose of rFVIIa. Thirty-one patients (86.1%) received only 1 dose of rFVIIa, with the majority (75%) of first-time doses given in the operating room during the operative procedure. The incidence of the combined endpoint of thrombosis between patients in the rFVIIa era who received rFVIIa (11.4%) versus those who did not receive rFVIIa (5.5%) was not significantly different statistically (p = 0.145). Significantly more patients experienced postoperative renal failure (23.1% vs 5.6%), and required dialysis (11.5% vs 1.2%) in the rFVIIa group compared with patients who did not receive rFVIIa in the rFVIIa era (p = 0.005 and 0.009, respectively).

The authors adequately pointed out the limitation that using historical control groups for comparison based on the complexity of the primary operation may have led to potential confounders. However, to allow an unbiased comparison between patients receiving rFVIIa and controls, the authors might have used the propensity score methodology. These analyses would have addressed imbalances due to measured confounders.

We found the investigation very interesting and believe it may confirm our previous data in patients with acute aortic dissection undergoing surgery with deep hypothermic circulatory arrest [2].

	References

Top References

 

1. Bowman LJ, Uber WE, Stroud MR, et al. Use of recombinant activated factor VII concentrate to control postoperative hemorrhage in complex cardiovascular surgery Ann Thorac Surg 2008;85:1669-1676.[Abstract/Free Full Text]
2. Tritapepe L, De Santis V, Vitale D, et al. Recombinant activated factor VII for refractory bleeding after acute aortic dissection surgery: a propensity score analysis Crit Care Med 2007;35:1685-1690.[Medline]

This article has been cited by other articles:

				J. S. Ikonomidis, W. Uber, and M. Stroud Reply. Ann. Thorac. Surg., December 1, 2008; 86(6): 2025 - 2025. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by De Santis, V. Articles by Pietropaoli, P. Search for Related Content PubMed PubMed Citation Articles by De Santis, V. Articles by Pietropaoli, P. Related Collections Cardiac - pharmacology Related Article