Early experience with activated recombinant factor VII for intractable hemorrhage after cardiovascular surgery

Michael E. Halkos, Jerrold H. Levy, Edward Chen, V. Seenu Reddy, Omar M. Lattouf, Robert A. Guyton, Howard Song

    Research output: Contribution to journalArticle

    32 Citations (Scopus)

    Abstract

    Background. Intractable hemorrhage after complex cardiovascular operations is a serious and potentially lethal complication. We report our experience with the use of activated recombinant factor VIIa (rFVIIa) as rescue therapy for patients with refractory postoperative hemorrhage. Methods. From April 2002 through December 2003, 9 patients received rFVIIa for intractable hemorrhage after cardiovascular surgery. Patients underwent aortic surgery (2), coronary artery bypass graft surgery (4), double valve operations (2), and mitral valve replacement (1). Four of these procedures were reoperations. Intraoperative aprotinin was used in all patients. All patients underwent standard heparinization (300 IU/kg) before cardiopulmonary bypass and reversal with protamine. Results. Five patients underwent reexploration for mediastinal hemorrhage before treatment; 2 were reexplored twice. The average transfusion requirement before rFVIIa administration was 9 U of blood, 7 U of plasma, 22 U of platelets, and 19 U of cryoprecipitate. rFVIIa was administered as an intravenous bolus at 68 to 120 μg/kg. Mean time of administration from the first operation was 10.9 ± 7.2 hours. At the time of activated rFVIIa administration, chest tube drainage averaged 640 mL/h. In all patients, chest tube drainage was dramatically reduced to less than 100 mL/h within 5 hours after drug delivery. None of the patients required reexploration after treatment. There were no postoperative neurologic or cardiovascular complications. Conclusions. When used as rescue therapy for intractable hemorrhage after cardiovascular surgery, rFVIIa may be effective in promoting hemostasis, preventing reexploration, and reducing transfusion requirements.

    Original languageEnglish (US)
    Pages (from-to)1303-1306
    Number of pages4
    JournalAnnals of Thoracic Surgery
    Volume79
    Issue number4
    DOIs
    StatePublished - Apr 2005

    Fingerprint

    Factor VIIa
    Hemorrhage
    Chest Tubes
    Drainage
    Postoperative Hemorrhage
    Aprotinin
    Protamines
    Therapeutics
    Hemostasis
    Cardiopulmonary Bypass
    Mitral Valve
    Reoperation
    Coronary Artery Bypass
    Nervous System
    recombinant FVIIa
    Blood Platelets
    Transplants

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Surgery

    Cite this

    Early experience with activated recombinant factor VII for intractable hemorrhage after cardiovascular surgery. / Halkos, Michael E.; Levy, Jerrold H.; Chen, Edward; Reddy, V. Seenu; Lattouf, Omar M.; Guyton, Robert A.; Song, Howard.

    In: Annals of Thoracic Surgery, Vol. 79, No. 4, 04.2005, p. 1303-1306.

    Research output: Contribution to journalArticle

    Halkos, Michael E. ; Levy, Jerrold H. ; Chen, Edward ; Reddy, V. Seenu ; Lattouf, Omar M. ; Guyton, Robert A. ; Song, Howard. / Early experience with activated recombinant factor VII for intractable hemorrhage after cardiovascular surgery. In: Annals of Thoracic Surgery. 2005 ; Vol. 79, No. 4. pp. 1303-1306.
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    abstract = "Background. Intractable hemorrhage after complex cardiovascular operations is a serious and potentially lethal complication. We report our experience with the use of activated recombinant factor VIIa (rFVIIa) as rescue therapy for patients with refractory postoperative hemorrhage. Methods. From April 2002 through December 2003, 9 patients received rFVIIa for intractable hemorrhage after cardiovascular surgery. Patients underwent aortic surgery (2), coronary artery bypass graft surgery (4), double valve operations (2), and mitral valve replacement (1). Four of these procedures were reoperations. Intraoperative aprotinin was used in all patients. All patients underwent standard heparinization (300 IU/kg) before cardiopulmonary bypass and reversal with protamine. Results. Five patients underwent reexploration for mediastinal hemorrhage before treatment; 2 were reexplored twice. The average transfusion requirement before rFVIIa administration was 9 U of blood, 7 U of plasma, 22 U of platelets, and 19 U of cryoprecipitate. rFVIIa was administered as an intravenous bolus at 68 to 120 μg/kg. Mean time of administration from the first operation was 10.9 ± 7.2 hours. At the time of activated rFVIIa administration, chest tube drainage averaged 640 mL/h. In all patients, chest tube drainage was dramatically reduced to less than 100 mL/h within 5 hours after drug delivery. None of the patients required reexploration after treatment. There were no postoperative neurologic or cardiovascular complications. Conclusions. When used as rescue therapy for intractable hemorrhage after cardiovascular surgery, rFVIIa may be effective in promoting hemostasis, preventing reexploration, and reducing transfusion requirements.",
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