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ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2011, Number 1

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An Med Asoc Med Hosp ABC 2011; 56 (1)

Five years experience in the use of rFVIIa in patients with bleeding in the ABC Medical Center. A therapeutic alternative

Núñez MME, Sánchez NMR, Álvarez SP

Language: Spanish
References: 26
Page: 11-15
PDF size: 57.01 Kb.


ABSTRACT

Background: The use of rFVII (recombinant activated factor VII) was discovered and introduced since the 1990’s for the management of hemophilia patients with coagulation inhibitors with good results. So far, its use has been described in reversal of anticoagulation, surgery and trauma, liver disease and liver transplantation, non-traumatic brain hemorrhage, thrombocytopenia, and platelet dysfunction showing favorable results. Objective: To describe the first five years of experience at the ABC Medical Center with the use of rFVII in patients with acute bleeding. Material and methods: We performed a retrospective, descriptive, observational study from January 1, 2005 through March 31, 2009 in the ABC Medical Center. The study included information from the Blood Bank records of patients that required the application of rFVII during their hospital stay, in addition to the dose administered and blood components received. Diagnosis, clinical service and indication for the administration of rFVII, clotting time and fibrinogen before and after the application of rFVII were studied. Results: We included 55 adult non-hemophiliac patients who had rFVII administered. Average age of the patients was 60 years for both genders. Forty-seven patients underwent surgery, clinical service showed increased use of rFVII in patients that underwent cardiovascular surgery. 87.5% of patients received more than 10 blood components. Improvement was the reason for 75% of the patients being discharged from the hospital. Fourteen patients died, seven due to disseminated vascular coagulation, three from multiple organ failure, two of septic shock, one from cardiogenic shock, and one from mesenteric thrombosis. Coagulopathy was observed in 20 patients with 27.4 PT (prothrombin time) and aPTP (activated partial thromboplastin) of 88.8 seconds. The application of rFVII was corrected in 20 patients with 14.3 PT and aPTP of 37.5 seconds. Conclusions: rFVII therapy is not first-line in non-hemophiliac patients with acute bleeding and should always be used as adjunct therapy under strict monitoring conditions of coagulation tests in vitro. A guide based on available evidence can serve to sustain the proper use of adjuvant rFVII therapy, substantially diminish abuse and reduce costs.


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