Successful Hemostasis with Recombinant Activated Factor VII in a Patient with Massive Hepatic Subcapsular Hematoma

Abstract

Recombinant activated coagulation factor VII (rFVIIa) is known to be effective in the management of acquired deficiencies of factor VII and platelet function defects. But recently, rFVIIa has been successfully used to treat ongoing bleeding in disseminated intravascular coagulopathy (DIC) condition. The patient reported here was suspected to be suffering from toxic hepatitis on admission. After percutaneous liver biopsy, bleeding occurred and did not stop even after right hepatic artery embolization. The patient developed a severe hemorrhage that resulted in hypovolemic shock, hemoperitoneum, and a massive subcapsular hematoma. The patient then developed DIC due to massive transfusion, as well as acute liver necrosis. The patient was given 400 μg/kg of rFVIIa. Recombinant factor VIIa was administered in an attempt to control the bleeding. This stabilized the hemoglobin levels of the patient. The patient gradually recovered in 4 months. In conclusion, this case suggests that rFVIIa can be successfully used for the hemostasis of uncontrolled bleeding in DIC.

Recombinant factor VIIa as last‐resort treatment of desperate haemorrhage

“…Additionally, we also report immediate clinical response to rFVIIa in rare conditions not previously or only very rarely described. This includes the cessation of desperate haemorrhage in patients with splenic rupture, liver rupture, massive haemorrhage after percutaneous liver biopsy, diffuse haemorrhage during surgical operations for aortic dissection, retroperitoneal bleeding secondary to enoxaparine treatment, and cessation of massive alveolar haemorrhage and immediate recovery of fulminant DIC in a near‐drowning victim . Six of our patients received rFVIIa while on ECMO without clotting in the artificial circulation that is in line with a recent report on four paediatric patients .…”

Subcapsular hepatic hematoma as a complicating cardiac surgery

“…3 Timely percutaneous external drainage of large hematomas prevents functional hepatocyte compression. 3,6 However, the drainage reportedly interfered with hemostasis due to the tamponade effect of hematoma. 6 In our case, HCS occurred locally and the hematoma was not drained.…”

“…3,6 However, the drainage reportedly interfered with hemostasis due to the tamponade effect of hematoma. 6 In our case, HCS occurred locally and the hematoma was not drained.…”