Highlights
- •Recombinant Factor VIIa (rFVIIa) has been used for cardiac surgical bleeding in an off-label manner
- •Previous studies have identified that low dose rFVIIa (<40 mcg/kg) may have less thrombotic potential than the higher approved doses for hemophilia (90 mcg/kg)
- •The optimal timing of when to administer rFVIIa during the course of cardiac surgical bleeding resuscitation is unknown
- •The current analyzed timing of administration of low dose rFVIIa in terms of number of allogeneic transfusions and found unclear benefit without increased adverse events
Objective
Recombinant factor VII (rFVIIa) is used to treat cardiac surgical bleeding in an off-label
manner. However, optimal dosing and timing of administration to provide efficacious
yet safe outcomes remain unknown.
Design
Retrospective, observational study.
Setting
Tertiary care academic center.
Participants
Cardiac surgical patients (N = 214) who received low-dose rFVIIa for cardiac surgical
bleeding.
Interventions
Patients were allocated into one of three groups based on timing of rFVIIa administration
during the course of bleeding resuscitation based on the number of hemostatic products
given before rFVIIa administration: group one = ≤one products (n = 82); group two = two-to-four
products (n = 73); and group three= ≥five products (n = 59).
Measurements and Main Results
Patients who received low-dose rFVIIa later in the course of bleeding resuscitation
(group three) had longer intensive care unit stays (p = 0.014) and increased incidence
of postoperative renal failure when compared with group one (p = 0.039). Total transfusions
were lowest in patients who received rFVIIa early in the course of resuscitation (group
one) (median, two [interquartile range (IQR), 1-4.75]) and highest in group three
(median, 11 [IQR, 8-14]; p < 0.001). Subsequent blood product transfusions after rFVIIa
administration were highest in group two (p = 0.003); however, the median for all
three groups was two products. There were no differences in thrombosis, reexplorations,
or mortality in any of the groups.
Conclusions
This study identified no differences in adverse outcomes based on timing of administration
of low-dose rFVIIa for cardiac surgical bleeding defined by stage of resuscitation,
but the benefits of early administration remain unclear.
Graphical abstract
Graphical Abstract
Key Words
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Article info
Publication history
Published online: May 06, 2021
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