Anestéziológia a intenzívna medicína 2/2014

The use of recombinant FVIIa in cardiac surgery patients – our clinical experience

Recombinant FVIIa, in cardiac surgery has an off-label use for the management of postoperative life-threatening bleeding refractory to the usual treatment protocols. In this retrospective study, we evaluate the use of rFVIIa in our Institute between the years 2008–2012. During that time 5989 patients had cardiac surgery, and 4238 of them underwent surgery with the use of the cardiopulmonary by-pass. 70 patients, 50 men and 20 women received rFVIIa. One dose was applied in 50 patients (71.4%). Minimal dose was 45 µg/kg, maximal dose 137 µg/kg, mean dose 88.9 µg/kg, median dose 95 µg/kg. Second dose was needed in 18 patients (25.7%), only two patients (2.9%) needed three doses. In half of patients treatment was necessary already at operation theatre. The need of operation revisions: before rFVIIa was needed in 34 patients (48.6%) while after treatment only in 14 patients (20%). We found significant differences in mortality regarding age (p=0.018), SOFA score (p<0.001) and APACHE score (p<0.001); these variables could help to select patients with benefit from rFVIIa administration. Analysis of clinical and laboratory parameters after rFVIIa administration found significant decrease of bleeding, the need of blood transfusions and improvement of PT and aPTT.

Keywords: activated recombinant factor VII (rFVIIa), life-threatening bleeding, cardiac surgery, cardiopulmonary bypass.