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Eur J Cardiothorac Surg 2005;28:254-258
© 2005 Elsevier Science NL

Original articles

Recombinant activated factor VII in the management of life-threatening bleeding in cardiac surgery

^a Department of Cardiothoracic Anaesthesiology & Intensive Care, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden
^b Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden

Received 16 December 2004; received in revised form 12 April 2005; accepted 15 April 2005.

^* Corresponding author. Tel.: +46 31 342 1000; fax: +46 31 413 862. (Email: monica.hyllner{at}vgregion.se).

Abstract

Objective: Massive perioperative bleeding is a potential complication of cardiac surgery, and may persist despite conventional interventions. RFVIIa is being increasingly used as additional therapy, and the aim of the present study was to describe our experience with rFVIIa in the management of life-threatening bleeding in adult cardiac surgery. Methods: Retrospective chart review of 24 patients undergoing a variety of cardiac procedures was performed at Sahlgrenska University Hospital between January and August 2004. The patients developed life-threatening bleeding during or after surgery despite conventional medical therapy and transfusion of blood products, and received rFVIIa as additional therapy. Results: RFVIIa was administered as a median bolus dose of 60µg/kg. Nineteen patients received one dose of rFVIIa; the bleeding stopped or decreased in 18 of them. Five patients received repeated doses of rFVIIa. Fifteen patients were reexplored due to massive postoperative bleeding or cardiac tamponade and a surgical source of bleeding was identified in six of these patients. A statistically significant reduction in chest drain losses after administration of rFVIIa was demonstrated. No adverse reactions were noted. Conclusions: RFVIIa was successfully used as an additional therapy both during and after cardiac surgery, when bleeding was refractory to conventional methods. Bleeding stopped eventually in all patients and none of the patients exsanguinated.

Key Words: Cardiac surgery • Recombinant activated factor VII • Life-threatening bleeding

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