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Early experience with activated recombinant factor VII for intractable hemorrhage after cardiovascular surgery.

Publication ,  Journal Article
Halkos, ME; Levy, JH; Chen, E; Reddy, VS; Lattouf, OM; Guyton, RA; Song, HK
Published in: Ann Thorac Surg
April 2005

BACKGROUND: Intractable hemorrhage after complex cardiovascular operations is a serious and potentially lethal complication. We report our experience with the use of activated recombinant factor VIIa (rFVIIa) as rescue therapy for patients with refractory postoperative hemorrhage. METHODS: From April 2002 through December 2003, 9 patients received rFVIIa for intractable hemorrhage after cardiovascular surgery. Patients underwent aortic surgery (2), coronary artery bypass graft surgery (4), double valve operations (2), and mitral valve replacement (1). Four of these procedures were reoperations. Intraoperative aprotinin was used in all patients. All patients underwent standard heparinization (300 IU/kg) before cardiopulmonary bypass and reversal with protamine. RESULTS: Five patients underwent reexploration for mediastinal hemorrhage before treatment; 2 were reexplored twice. The average transfusion requirement before rFVIIa administration was 9 U of blood, 7 U of plasma, 22 U of platelets, and 19 U of cryoprecipitate. rFVIIa was administered as an intravenous bolus at 68 to 120 mug/kg. Mean time of administration from the first operation was 10.9 +/- 7.2 hours. At the time of activated rFVIIa administration, chest tube drainage averaged 640 mL/h. In all patients, chest tube drainage was dramatically reduced to less than 100 mL/h within 5 hours after drug delivery. None of the patients required reexploration after treatment. There were no postoperative neurologic or cardiovascular complications. CONCLUSIONS: When used as rescue therapy for intractable hemorrhage after cardiovascular surgery, rFVIIa may be effective in promoting hemostasis, preventing reexploration, and reducing transfusion requirements.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

April 2005

Volume

79

Issue

4

Start / End Page

1303 / 1306

Location

Netherlands

Related Subject Headings

  • Respiratory System
  • Recombinant Proteins
  • Postoperative Hemorrhage
  • Humans
  • Health Care Costs
  • Factor VIIa
  • Cardiovascular Surgical Procedures
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Halkos, M. E., Levy, J. H., Chen, E., Reddy, V. S., Lattouf, O. M., Guyton, R. A., & Song, H. K. (2005). Early experience with activated recombinant factor VII for intractable hemorrhage after cardiovascular surgery. Ann Thorac Surg, 79(4), 1303–1306. https://doi.org/10.1016/j.athoracsur.2004.09.034
Halkos, Michael E., Jerrold H. Levy, Edward Chen, V Seenu Reddy, Omar M. Lattouf, Robert A. Guyton, and Howard K. Song. “Early experience with activated recombinant factor VII for intractable hemorrhage after cardiovascular surgery.Ann Thorac Surg 79, no. 4 (April 2005): 1303–6. https://doi.org/10.1016/j.athoracsur.2004.09.034.
Halkos ME, Levy JH, Chen E, Reddy VS, Lattouf OM, Guyton RA, et al. Early experience with activated recombinant factor VII for intractable hemorrhage after cardiovascular surgery. Ann Thorac Surg. 2005 Apr;79(4):1303–6.
Halkos, Michael E., et al. “Early experience with activated recombinant factor VII for intractable hemorrhage after cardiovascular surgery.Ann Thorac Surg, vol. 79, no. 4, Apr. 2005, pp. 1303–06. Pubmed, doi:10.1016/j.athoracsur.2004.09.034.
Halkos ME, Levy JH, Chen E, Reddy VS, Lattouf OM, Guyton RA, Song HK. Early experience with activated recombinant factor VII for intractable hemorrhage after cardiovascular surgery. Ann Thorac Surg. 2005 Apr;79(4):1303–1306.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

April 2005

Volume

79

Issue

4

Start / End Page

1303 / 1306

Location

Netherlands

Related Subject Headings

  • Respiratory System
  • Recombinant Proteins
  • Postoperative Hemorrhage
  • Humans
  • Health Care Costs
  • Factor VIIa
  • Cardiovascular Surgical Procedures
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1103 Clinical Sciences