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Recombinant activated factor VII in cardiac surgery

Published online by Cambridge University Press:  01 June 2007

M. Ranucci  and
G. Isgrò
M. Ranucci*
Affiliation:
Cardiothoracic Anaesthesia and Intensive Care Department, IRCCS Policlinico S. Donato, Italy
G. Isgrò
Affiliation:
Cardiothoracic Anaesthesia and Intensive Care Department, IRCCS Policlinico S. Donato, Italy
*
Correspondence to: Marco Ranucci, Head Cardiothoracic Anesthesia Dept, IRCCS Policlinico S. Donato, Via Morandi 30, 20097 San Donato Milanese, Milan (Italy). E-mail: cardioanestesia@virgilio.it; Tel: +39 02 52774320;Fax: +39 02 55602262
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Summary

Background and objective

Recombinant activated factor VII (rFVIIa) is a pharmacologic compound approved for the use in patients with congenital or acquired hemophilia and inhibiting antibodies toward factor VIII or IX. In recent years its use has been proposed in surgical patients demonstrating a lifethreatening bleeding, refractory to the standard therapies. The present study is a review of the clinical information available on the use of rFVIIa in cardiac surgery patients.

Methods

Current literature was investigated using a Pubmed search with appropriate key words (rFVIIa OR recombinant activated factor VII AND cardiac surgery).

Results

35 articles were found. These are 11 case reports, 12 case series, 5 review articles, 3 retrospective studies, 2 letters to the Editor, and only one prospective, double-blinded, randomized clinical trial (RCT). The majority of the case reports and case series report a beneficial effect of this drug in the treatment of refractory bleeding. Comparative retrospective studies show conflicting results, and the only RCT demonstrate a significant reduction of allogeneic blood products use in patients treated with rFVIIa. No definitive information is available with respect to thromboembolic complications and general safety of this therapy.

Conclusions

rFVIIa is a promising agent for intractable bleeding in surgical patients. However, large prospective randomized trials are needed to define efficacy, dose, and potential side-effects.

Keywords

coagulation factorsblood transfusionssurgery
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue S40 , June 2007 , pp. 83 - 88
Copyright
Copyright © European Society of Anaesthesiology 2007

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