Successful outcome of a cirrhotic patient with postoperative haematuria treated with a single high dose of recombinant factor VIIa

Abstract

Recombinant factor VIIa (rfVIIa) has been widely used for the treatment and prevention of bleeding episodes in haemophiliacs with high-titre inhibitors. High single doses are the treatment of choice for joint and muscle bleeds in those patients. There are only a few reports on the value of rfVIIa in cirrhotic patients with haemostatic impairment but this drug can consistently correct the prothrombin time in these individuals. We report a case of a good response to a single high dose of rfVIIa in a patient with advanced liver disease who suffered from severe refractory postoperative haematuria.

Recombinant factor VIIa

“…Results showed that rFVIIa significantly reduced acute bleeding and re-bleeding in patients with moderate to severe liver disease and variceal bleeding. 69 Case studies demonstrating the use of rFVIIa in liver disease associated with other forms of bleeding including haematuria and bleeding secondary to surgery and dental extractions have also been published 28,65,70 adding anecdotal support to the above studies. Safety and efficacy in children with coagulopathy secondary to liver disease has been demonstrated in a single study by Brown et al in a series of 15 patients.…”

“…Decreased synthesis of vitamin K dependent coagulation factors, particularly factor VII, protein C and protein S, increased fibrinolysis and thrombocytopaenia may all play a role. Traditional therapies have included vitamin K, FFP, desmopressin, platelets and cryoprecipitate 44,60,65 …”

“…Traditional therapies have included vitamin K, FFP, desmopressin, platelets and cryoprecipitate. 44,60,65 A preliminary trial by Bernstein et al in 1997 found rFVIIa to be effective in transiently reversing prolonged prothrombin time (PT) in a group of nonbleeding cirrhotic patients. In a single-centre, dose escalation trial, 10 patients with cirrhosis whose PT did not correct to within 2 seconds above the normal range, received 5, 20 and 80 µg/kg during a 3-week study period.…”

The Use of Recombinant Factor VIIa in Surgical Bleeding in Nonhemophiliac Patients

“…A 58-year-old man with Child-Pugh stage B liver cirrhosis developed profuse hematuria after transurethral resection of a bladder transitional cell carcinoma. 26 The hemorrhage failed to respond to multiple transfusions, two endoscopic surgical procedures and a selective arterial embolization. Seven weeks after the original surgery, a single bolus of rFVIIa at a dose of 137 µg/kg was administered, in response to ongoing bleeding and anemia, which resulted in cessation of hemorrhage.…”

Factor VII Recombinante Activado para el Tratamiento de la Hemorragia de Difícil Control en UCI, Una Serie de Casos

“…8 En el mismo año 1999 fue reportado por Kenet y col. el uso del Factor VIIa, como tratamiento compasivo, en un soldado israelí quien tuvo una hemorragia masiva refractaria al tratamiento con hemoderivados, producto de una herida por proyectil de alta velocidad en la vena cava inferior, con un resultado exitoso. 9 A partir de ese momento han sido publicados varias series y reporte de casos, [10][11][12][13][14][15][16] así como algunos estudios aleatorizados acerca de la administración del Factor VIIa en pacientes no hemofílicos con hemorragia masiva secundaria a trauma y cirugía. 17,18 De igual manera, ha sido también reportado el uso del Factor VIIa en pacientes no hemofílicos con hemorragia masiva posterior a cirugía cardiaca, 18 en hemorragia digestiva e insuficiencia hepática, 19 hemorragia masiva en pacientes críticos, 20 y en hemorragia intracerebral 21 llegando incluso a formularse guías clínicas de recomendación para la administración del Factor VIIa.…”