Recombinant Factor VIIa to Manage Major Bleeding from Newer Parenteral Anticoagulants

Abstract

rFVIIa may be considered to manage major refractory bleeding from newer parenteral anticoagulant agents when the benefit is thought to outweigh the thrombotic risk.

Bivalirudin in Pediatric Patients Maintained on Extracorporeal Life Support

“…The median time to initial goal activated partial thromboplastin time was 4 hours (range, 1-25), and the time to 90% to 110% activated partial thromboplastin time goal was 2 hours (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. The median number of interventions to activated partial thromboplastin time goal was 1 (0-9) and interventions to 90% to 110% goal was 0 (0-6).…”

“…The relatively short half-life of bivalirudin (10-24 min in healthy adults) may also be advantageous compared with alternatives argatroban (39-51 min in healthy adults) and lepirudin (78 min in healthy adults) for titration or reversal of anticoagulation (4,12,13). Although data supporting the reversal of direct thrombin inhibitors is limited, reversal of bivalirudin using recombinant factor VII (rFVIIa) is more promising compared with argatroban and lepirudin (14)(15)(16)(17)(18).…”

Correction of Coagulopathy for Percutaneous Interventions

“…A review of the literature from January 2000 to December 2009 reports that factor VIIa has been used to reverse bleeding after enoxaparin and fondaparinux therapy in 7 and 2 cases respectively. 33 It was effective/partially effective in all the enoxaparin cases but only in one of the fondaparinux cases. 33 Factor VIIa given 2 hours after administration of fondaparinux to healthy volunteers normalized the PT and PTT in all subjects.…”

“…33 It was effective/partially effective in all the enoxaparin cases but only in one of the fondaparinux cases. 33 Factor VIIa given 2 hours after administration of fondaparinux to healthy volunteers normalized the PT and PTT in all subjects. 34 Although the direct thrombin inhibitors have relatively short half-lives (39-50 minutes and 80 minutes for argatroban and lepirudin, respectively), they do not yet have a proven antidote (Table 3).…”

Pharmacology of Peripheral Arterial Disease in the Angio Suite: What Every Interventionalist Should Know

“…24 Bleeding complications with both bivalirudin and argatroban can be managed with recombinant factor VIIa. 25 Though treatment of patients presenting with acute limb ischemia (ALI) is beyond the scope of this discussion, endovascular arterial interventions will occasionally be complicated by arterial thrombus formation. Effective strategies for thrombectomy and thrombolysis are essential for patient safety and acceptable outcomes.…”