Recombinant human FVIIa for reducing the need for invasive second‐line therapies in severe refractory postpartum hemorrhage: a multicenter, randomized, open controlled trial

Lavigne-Lissalde, Géraldine; Aya, Antoine G. M.; Mercier, F.J.; Roger-Christoph, S.; Chauleur, Céline; Morau, Estelle; Ducloy-Bouthors, A.-S.; Mignon, Alexandre; Raucoules, M.; Bongain, A.; Boehlen, Françoise; Moerloose, P de; Bouvet, Sophie; Fabbro‐Peray, Pascale; Gris, Jean‐Christophe

doi:10.1111/jth.12844

Cited by 71 publications

(37 citation statements)

References 37 publications

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“…A recent RCT of rFVIIa (60 mcg/kg) use in women with PPH refractory to uterotonics demonstrated reduced need for interventional secondline therapies in a third of patients, with nonfatal venous thrombosis in 1 in 20. 67 Platelet and fibrinogen thresholds of .50 3 10 9 /L and .1 g/L, respectively, were ensured. rFVIIa is used occasionally in our center when hemorrhage has not been controlled by other means and has avoided the need for hysterectomy.…”

Section: Recombinant Fviiamentioning

confidence: 99%

How I treat postpartum hemorrhage

Pavord

Maybury

2015

Blood

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Worldwide, ∼800 women die every day from preventable causes related to pregnancy or childbirth. The single most common cause is severe bleeding, which can kill a healthy woman within hours if care is substandard or delayed. Improved antenatal practices have led to the early identification of at-risk women and modern technology and new techniques have enabled effective management strategies so that now, in the western world, most of the morbidity and mortality arises from those cases which occur unexpectedly and could not have been predicted. Prompt and effective management and multidisciplinary involvement is paramount to save the lives of these women. We use a case report to illustrate and discuss the main elements of management of this condition.

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Section: Recombinant Fviiamentioning

confidence: 99%

How I treat postpartum hemorrhage

Pavord

Maybury

2015

Blood

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“…To be effective, rhVIIa requires correction of hypothermia, acidosis, fibrinogen levels, and anaemia [100]. If haemorrhage could not be controlled by other measures, rhFVIIa could lower the need of second-line therapies [101]. In a prospective cohort study with 22 patients with severe PPH rhVIIa contributed to the control of PPH and hysterectomy was avoided [102].…”

Section: Recombinant Activated Human Factor VII (Rhfviia)mentioning

confidence: 99%

Patient blood management (PBM) in pregnancy and childbirth: literature review and expert opinion

Surbek

Vial

Girard

et al. 2019

Arch Gynecol Obstet

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Purpose Patient blood management [PBM] has been acknowledged and successfully introduced in a wide range of medical specialities, where blood transfusions are an important issue, including anaesthesiology, orthopaedic surgery, cardiac surgery, or traumatology. Although pregnancy and obstetrics have been recognized as a major field of potential haemorrhage and necessity of blood transfusions, there is still little awareness among obstetricians regarding the importance of PBM in this area. This review, therefore, summarizes the importance of PBM in obstetrics and the current evidence on this topic. Method We review the current literature and summarize the current evidence of PBM in pregnant women and postpartum with a focus on postpartum haemorrhage (PPH) using PubMed as literature source. The literature was reviewed and analysed and conclusions were made by the Swiss PBM in obstetrics working group of experts in a consensus meeting. Results PBM comprises a series of measures to maintain an adequate haemoglobin level, improve haemostasis and reduce bleeding, aiming to improve patient outcomes. Despite the fact that the WHO has recommended PBM early 2010, the majority of hospitals are in need of guidelines to apply PBM in daily practice. PBM demonstrated a reduction in morbidity, mortality, and costs for patients undergoing surgery or medical interventions with a high bleeding potential. All pregnant women have a significant risk for PPH. Risk factors do exist; however, 60% of women who experience PPH do not have a pre-existing risk factor. Patient blood management in obstetrics must, therefore, not only be focused on women with identified risk factor for PPH, but on all pregnant women. Due to the risk of PPH, which is inherent to every pregnancy, PBM is of particular importance in obstetrics. Although so far, there is no clear guideline how to implement PBM in obstetrics, there are some simple, effective measures to reduce anaemia and the necessity of transfusions in women giving birth and thereby improving clinical outcome and avoiding complications. Conclusion PBM in obstetrics is based on three main pillars: diagnostic and/or therapeutic interventions during pregnancy, during delivery and in the postpartum phase. These three main pillars should be kept in mind by all professionals taking care of pregnant women, including obstetricians, general practitioners, midwifes, and anaesthesiologists, to improve pregnancy outcome and optimize resources.

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“…Randomized trials investigating PPH treatments have used a range of blood loss volumes in their inclusion criteria, to identify women that could benefit from treatment: 500 ml [11], [12], [13], [14], 700 ml [15], [16], 800 ml [17], 1000 ml [18] and 1500 ml [19]. Other authors have used a fall in haemoglobin or haematocrit as a definition, to avoid the difficulties of measurement or estimation of blood loss [20], [21].…”

Section: Preamblementioning

confidence: 99%