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Intraoperative use of low-dose recombinant activated factor VII during thoracic aortic operations.

Publication ,  Journal Article
Andersen, ND; Bhattacharya, SD; Williams, JB; Fosbol, EL; Lockhart, EL; Patel, MB; Gaca, JG; Welsby, IJ; Hughes, GC
Published in: Ann Thorac Surg
June 2012

BACKGROUND: Numerous studies have supported the effectiveness of recombinant activated factor VII (rFVIIa) for the control of bleeding after cardiac procedures; however safety concerns persist. Here we report the novel use of intraoperative low-dose rFVIIa in thoracic aortic operations, a strategy intended to improve safety by minimizing rFVIIa exposure. METHODS: Between July 2005 and December 2010, 425 consecutive patients at a single referral center underwent thoracic aortic operations with cardiopulmonary bypass (CPB); 77 of these patients received intraoperative low-dose rFVIIa (≤60 μg/kg) for severe coagulopathy after CPB. Propensity matching produced a cohort of 88 patients (44 received intraoperative low-dose rFVIIa and 44 controls) for comparison. RESULTS: Matched patients receiving intraoperative low-dose rFVIIa got an initial median dose of 32 μg/kg (interquartile range [IQR], 16-43 μg/kg) rFVIIa given 51 minutes (42-67 minutes) after separation from CPB. Patients receiving intraoperative low-dose rFVIIa demonstrated improved postoperative coagulation measurements (partial thromboplastin time 28.6 versus 31.5 seconds; p=0.05; international normalized ratio, 0.8 versus 1.2; p<0.0001) and received 50% fewer postoperative blood product transfusions (2.5 versus 5.0 units; p=0.05) compared with control patients. No patient receiving intraoperative low-dose rFVIIa required postoperative rFVIIa administration or reexploration for bleeding. Rates of stroke, thromboembolism, myocardial infarction, and other adverse events were equivalent between groups. CONCLUSIONS: Intraoperative low-dose rFVIIa led to improved postoperative hemostasis with no apparent increase in adverse events. Intraoperative rFVIIa administration in appropriately selected patients may correct coagulopathy early in the course of refractory blood loss and lead to improved safety through the use of smaller rFVIIa doses. Appropriately powered randomized studies are necessary to confirm the safety and efficacy of this approach.

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

June 2012

Volume

93

Issue

6

Start / End Page

1921 / 1928

Location

Netherlands

Related Subject Headings

  • Respiratory System
  • Recombinant Proteins
  • Propensity Score
  • Postoperative Hemorrhage
  • Middle Aged
  • Matched-Pair Analysis
  • Male
  • Intraoperative Period
  • Humans
  • Hospital Costs
 

Citation

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Chicago
ICMJE
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Andersen, N. D., Bhattacharya, S. D., Williams, J. B., Fosbol, E. L., Lockhart, E. L., Patel, M. B., … Hughes, G. C. (2012). Intraoperative use of low-dose recombinant activated factor VII during thoracic aortic operations. Ann Thorac Surg, 93(6), 1921–1928. https://doi.org/10.1016/j.athoracsur.2012.02.037
Andersen, Nicholas D., Syamal D. Bhattacharya, Judson B. Williams, Emil L. Fosbol, Evelyn L. Lockhart, Mayur B. Patel, Jeffrey G. Gaca, Ian J. Welsby, and G Chad Hughes. “Intraoperative use of low-dose recombinant activated factor VII during thoracic aortic operations.Ann Thorac Surg 93, no. 6 (June 2012): 1921–28. https://doi.org/10.1016/j.athoracsur.2012.02.037.
Andersen ND, Bhattacharya SD, Williams JB, Fosbol EL, Lockhart EL, Patel MB, et al. Intraoperative use of low-dose recombinant activated factor VII during thoracic aortic operations. Ann Thorac Surg. 2012 Jun;93(6):1921–8.
Andersen, Nicholas D., et al. “Intraoperative use of low-dose recombinant activated factor VII during thoracic aortic operations.Ann Thorac Surg, vol. 93, no. 6, June 2012, pp. 1921–28. Pubmed, doi:10.1016/j.athoracsur.2012.02.037.
Andersen ND, Bhattacharya SD, Williams JB, Fosbol EL, Lockhart EL, Patel MB, Gaca JG, Welsby IJ, Hughes GC. Intraoperative use of low-dose recombinant activated factor VII during thoracic aortic operations. Ann Thorac Surg. 2012 Jun;93(6):1921–1928.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

June 2012

Volume

93

Issue

6

Start / End Page

1921 / 1928

Location

Netherlands

Related Subject Headings

  • Respiratory System
  • Recombinant Proteins
  • Propensity Score
  • Postoperative Hemorrhage
  • Middle Aged
  • Matched-Pair Analysis
  • Male
  • Intraoperative Period
  • Humans
  • Hospital Costs