Late Postoperative Segmental Lung Infarction After Use of Recombinant Activated Factor VII to Achieve Hemostasis

Abstract

Background: Recombinant activated factor VII (rFVIIa) has been approved by the U.S. Food and Drug Administration (FDA) for treatment of bleeding in patients with hemophilia A and B and other inhibitors to coagulation factors VIII and IX. However, since rFVIIa's approval, off-label use has increased for clinical situations, leading to the development of numerous side-effects. Case: The clinical course is presented of a high-risk 33-year-old G 3 P 2-0-0-2 parturient with twin gestation, diagnosed with placenta increta via ultrasound during prenatal evaluations. The patient had a cesarean section and a planned hysterectomy after delivery. Significant bleeding was present perioperatively and postoperatively, despite preoperative placement of intraoperative internal tourniquets via bilateral hypogastric balloons. Multiple units of packed red blood cells, fresh frozen plasma, cryoprecipitate, albumin, platelets, and rFVIIa were administered to facilitate hemostasis. Following two doses of rFVIIa, a pulmonary infarction developed, requiring a late pulmonary lobectomy. Results: The patient had a full recovery. Conclusions: rFVIIa should be used as approved by the FDA. Off-label use of rFVIIa should only occur in extenuating emergent hemorrhage situations in which the benefits outweigh the risks of serious postoperative complications. ( J GYNECOL SURG 29:203)