Anesthesia & Clinical Research
Open Access

Abstract

Recombinant Activated Factor VII (rFVIIa) Treatment of Refractory Bleeding in Cardiac Surgical Patients

Rabie Soliman, Makhlouf Belghith, Hassan Yousef, Faisal Alghadam and Adel Ragheb

Objective: Our aim to evaluate the efficacy and safety of rFVIIa in cardiac surgical patients with refractory bleeding. Design: The study was a retrospective study. Setting: Prince Sultan cardiac center, Saudia Arabia. Participants: Data were collected in patients who had undergone cardiac surgery and complicated by refractory bleeding. The study included 35 patients adults and 8 children. Interventions: rFVIIa administration. Measurements and main results: The rFVIIa effect was assessed by the decrease in the chest blood loss (The amount of bleeding was < 3ml/kg/hr without accumulation of blood inside the chest) and number of blood products (Packed red blood cells, platelets, fresh frozen plasma, and cryoprecipitate) given before and after rFVIIa administration was recorded. The dose of rFVIIa was 93.72 ± 17.39 μg/kg. All patients received single dose of rFVIIa, but nine patients received a second dose through half to one hour following the initial dose. The blood losses before rFVIIa administration was 7.47 ± 1.53 ml/kg/hr and decreased significantly to 2.37 ± 0.67 and 1.08 ± 0.42 ml/kg/hr in the next six and eighteen hours respectively (P=0.001)[paired test]. Before rFVIIa administration, the number of transfused packed RBC, fresh frozen plasma, platelets and cryoprecipitates were 11.25 ± 3.57, 11.35 ± 4.15, 11.77 ± 4.40 and 10.16 ± 3.76 units and decreased significantly to 5.930 ± 1.704, 3.86 ± 1.52, 3.65 ± 1.42 and 2.91 ± 2.11 units respectively after rFVIIa (P=0.00). Conclusion: In patients undergoing cardiac surgery exhibiting refractory bleeding, rFVIIa at a mean dose of 93.7 ± 17 μg/kg improved significantly hemostasis and decreased additional administration of blood products, without any complication related to rFVIIa.