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2011, Number 1

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Rev Mex Anest 2011; 34 (1)

Role of recombinant activated factor VII in bleeding after cardiac surgery. Its application in cardiovascular anesthesiology

Gómez-Ríos N, Rodríguez-Ortega MF, Tejero-Langarica A, Hernández-Mercado MA, Palma-Mercado J, Juárez-Lemus ÁM, Molina-Méndez FJ

Language: Spanish
References: 111
Page: 15-24
PDF size: 433.15 Kb.


ABSTRACT

Objective: To report the experience of the cardiovascular anesthesiology in the treatment of non-surgical bleeding with the use of the recombinant factor VII activated (rFVIIa). Setting: Medical Center of «Instituto de Seguridad Social del Estado de México y Municipios». Design: Observational, descriptive, retrospective, retrolective study of a series of cases. Statistical analysis: Percentages as summary measure for qualitative variables. Material and methods: Between June of 2005 to June of 2009, clinical records of the patients were reviewed, analyzed variables were: age, gender, type of cardiac surgery, anesthetic protocol, bleeding and complications, use of package blood, dose of rFVIIa, morbi-mortality. Results: 20 patients in a period of 4 years were studied, of which 16 were male, with age average of 59.4 years, weight average 63.8 kg. Cardiac procedure were: coronary artery by-pass grafting (4 cases), mitral + aortic valve replacement (4), coronary artery by-pass grafting + mitral valve replacement (3), mitral valve replacement + tricuspid valve annuloplasty (3), Bentall-Bono surgery (3) and aortic valve replacement (3). Mean cardiopulmonary by-pass time 83.4 min. Using cell-saver in all the cases and a volume average of 357.7 mL. The used dose of rFVIIa was 90 µg/kg, average of transfusion requirement were: red blood cells (4.0 U), fresh frozen plasma (6.2 U), cryoprecipitate (2.3 U), platelet concentrates (2.2 U). Chest tube drainage were before rFVIIa 1,425 mL and after 319.5 mL. Three patients were re-exploration and 45 µg/kg dose repeated. Only two complications for the anesthetic procedure and satisfactory evolution of 10 to 22 months. Conclusion: Our results suppose, that the use of rFVIIa as therapy of rescue for bleeding by coagulopathy after cardiovascular surgery is beneficial and diminishes the use of packed blood and re-exploration.


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