Potential uses of recombinant human factor VIIa in veterinary medicine

A rodenticide exposed and bleeding Beagle dog with hereditary factor VII deficiency

“…Furthermore, the immunogenicity and cross-reactivity of the human protein with the canine factor are concerns. 21,22 A recombinant human FVIIa dose of 0.05-0.3 mg/kg has normalized the cuticle bleeding time in FVIIa deficient Beagles. 21 Other potential therapeutic options in humans include fibrinolytic inhibitors, intermediate purity factor IX concentrates, and FVII concentrates.…”

“…Recombinant human FVIIa has been used in human trauma and surgical patients, and experimentally in dogs, as an alternative to plasma transfusion, but its efficacy and safety in dogs with FVII deficiency or other coagulopathies has not been extensively documented. Furthermore, the immunogenicity and cross‐reactivity of the human protein with the canine factor are concerns 21,22 . A recombinant human FVIIa dose of 0.05–0.3 μg/kg has normalized the cuticle bleeding time in FVIIa deficient Beagles 21 .…”

Use of recombinant human factor VIIa in 2 patients with postoperative noncompressible, abdominal hemorrhage

“…5 The effects of rFVIIa are limited to sites of injury because exposed tissue factor and activated platelets are required to exert its actions, which localizes its effects and prevents widespread activation of the hemostatic system. 5 rFVIIa was initially registered and used for human hemophiliac patients. One of the first off-label uses of rFVIIa was in a soldier who suffered extensive bleeding following a gunshot wound to the abdomen and, after administration of rFVIIa, there was dramatic control of hemorrhage.…”

“…3 In trauma, there are several hemostatic changes, and the use of rFVIIa in conjunction with other conventional hemostatic strategies may be helpful in controlling massive hemorrhage. 5 Other than trauma, uncontrolled hemorrhage in the postoperative period is a common and life-threatening consequence in human and veterinary patients. A randomized, placebo-controlled trial in human patients undergoing prostatectomy demonstrated that a single injection of rFVIIa perioperatively resulted in a 50% reduction of blood loss compared with placebo and eliminated the need for blood transfusion, which was required in 60% of the placebo-treated patients.…”

“…5 Clinical and experimental work has supported the use of rFVIIa in cases of thrombocytopenia and thrombocytopathia because supraphysiological doses have been shown to be more efficient in platelet procoagulant capacity and may have a significant hemostatic effect even in the presence of low platelets. 5 In people, the administration of rFVIIa to patients with warfarin intoxication resulted in marked reduction of PT and enhanced hemostasis. 3 Acute and chronic liver disease may result in decreased production of vitamin K-dependent coagulation proteins, and patients with liver disease are at increased risk of hemorrhage from procedures such as liver biopsies or surgical procedures.…”