Recombinant Activated Factor VII in Cardiac Surgery: Experience From the Australian and New Zealand Haemostasis Registry

Dunkley, Scott; Phillips, Louise Elizabeth; McCall, Peter R; Brereton, John; Lindeman, Robert; Jankelowitz, Gary; Cameron, Peter

doi:10.1016/j.athoracsur.2007.06.076

Cited by 56 publications

(37 citation statements)

References 33 publications

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“…These observations are further supported by data showing a reduced pro-coagulant response to recombinant activated factor VII when administered in severe hypothermia [13][14][15].…”

supporting

confidence: 73%

Cooling and reduced risk of clotting within the extracorporeal continuous renal replacement circuit

Bagshaw

Davenport

2008

Intensive Care Med

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Clotting of the extracorporeal circuit, with a corresponding loss of blood in the circuit remains the Achilles heel of continuous renal replacement therapies (CRRT) [1]. Pre-mature circuit clotting results not only in a loss of efficacy of treatment, but also an increase in nursing work load, and higher financial costs due to circuit replacement [2, 3].Early circuit clotting may be the consequence of numerous factors including bio-incompatibility, inadequate vascular access, and critical illness in general (including thrombin generation, thrombocytosis, blood transfusions etc.) [4][5][6][7][8], along with specific CRRT circuitrelated factors such as stasis of blood flow [7, 9], hemoconcentration [7], and blood-air contact in air-detection chambers [7].Hypothermia has long been known to affect coagulation [10, 11] and therapeutic hypothermia may useful for reducing the risk of thrombus formation [12]. These observations are further supported by data showing a reduced pro-coagulant response to recombinant activated factor VII when administered in severe hypothermia [13][14][15].Based on these observations, Krouzecky and colleagues now report on the deliberate cooling of blood in the extracorporeal CRRT circuit down to a temperature of 20°C as a novel technique for regional anticoagulation in an experimental porcine model [16]. This study randomized 12 anesthetized and ventilated pigs to 6 h of CRRT (neutral fluid balance, 20 mL/kg per h) with either regional blood cooling of the extracorporeal circuit (hypothermic circuit) or control (isothermic circuit). No anticoagulation was used. Regional temperature manipulation in the extracorporeal circuit was achieved by use of a cooling exchange device at the blood inflow tract (set at 20°C) and a concomitant warming exchange device at the blood return tract (set at 38°C), both of which were monitored and controlled by a central computer. Numerous parameters related to circuit patency (i.e. time to clotting, alarm-trigger pump stopping, transmembrane pressure) and coagulation status [i.e. thrombin-antithrombin complexes (TAT), thromboelastography (TEG)] were determined before, during and following the prescribed therapy. The authors also investigated whether regional blood cooling altered systemic hemodynamics or induced significant hemolysis compared with isothermic controls. The key finding of the study was that regional blood cooling was associated with patency of all the extracorporeal circuits for the duration of applied CRRT, whereas five of the six isothermic circuits prematurely clotted. The clotting in the isothermic circuits was associated with a significant increase in transmembrane pressures and an increase in detectable extracorporeal TAT complexes, compared to the hypothermic circuits. In addition, blood sampling from the hypothermic circuits showed evidence of a significant delay in clotting time and a decrease clotting rate when assessed by standardized TEG, a functional assay of clot formation and lysis.

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“…These observations are further supported by data showing a reduced pro-coagulant response to recombinant activated factor VII when administered in severe hypothermia [13][14][15].…”

supporting

confidence: 73%

Cooling and reduced risk of clotting within the extracorporeal continuous renal replacement circuit

Bagshaw

Davenport

2008

Intensive Care Med

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“…1 There has been an increasing number of reports of the use of rFVIIa to manage uncontrolled hemorrhage in clinical settings outside of these licensed indications, including cardiac surgery, trauma, and obstetrics. [2][3][4] Until recently, there have been few data on off-label use of rFVIIa in pediatric patients, and most have been limited to single case reports [5][6][7] and small or single-center case series, 8,9 including in cardiac surgery, [10][11][12] trauma, 13 and neurosurgery. [14][15][16] There are important differences between pediatric and adult patients with regard to their coagulation system and risk of thromboembolism, susceptibility to bleeding after cardiopulmonary bypass, 17 and the pharmacokinetics of rFVIIa.…”

mentioning

confidence: 97%

Off-Label Use of Recombinant Factor VIIa in Pediatric Patients

McQuilten,

Barnes,

Zatta

et al. 2012

Pediatrics

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“…More recently, recombinant FVIIa has been used off-label for salvage situations associated with persistent bleeding in cardiac operations. 475 There are small, single-center experiences in pediatric patients with intractable hemorrhage after cardiac surgery, among patients with known factor deficiency or coagulopathy after cardiac surgery, and among patients placed on ECMO after cardiac surgery with intractable hemorrhage. [476][477][478][479][480][481][482][483][484][485] These studies suggest that recombinant FVIIa is effective in decreasing postoperative bleeding, but thrombotic complications have been reported, including an arterial thrombus in an infant requiring amputation of a leg.…”

Section: Recombinant Fviiamentioning

confidence: 99%

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

Giglia¹,

Massicotte²,

Tweddell³

et al. 2013

Circulation

297

245

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Recombinant Activated Factor VII in Cardiac Surgery: Experience From the Australian and New Zealand Haemostasis Registry

Cited by 56 publications

References 33 publications

Cooling and reduced risk of clotting within the extracorporeal continuous renal replacement circuit

Cooling and reduced risk of clotting within the extracorporeal continuous renal replacement circuit

Off-Label Use of Recombinant Factor VIIa in Pediatric Patients

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

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