Use of recombinant factor VIIa for refractory hemorrhage during extracorporeal membrane oxygenation*

Abstract

The efficacy of rFVIIa in reducing intractable bleeding postcardiac surgery and in other coagulopathic states is being investigated. Despite theoretical concerns of thrombosis, these cases illustrate that there may be a role for the cautious use of rFVIIa in treating severe and intractable hemorrhage associated with ECMO.

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease

“…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. 484 The dose used among pediatric patients with intractable hemorrhage after cardiac surgery ranges from 30 to 180 μg/kg (recommended dose for patients with hemophilia, 90 μg/kg).…”

“…[483][484][485]509,510 In case reports and small uncontrolled series, bleeding was reported to decrease after the administration of recombinant FVIIa. 482,483,509 Two studies compared outcome among patients receiving recombinant FVIIa on ECMO with historic controls. Veldman and colleagues 485 reported on 7 patients receiving recombinant FVIIa for intractable hemorrhage while on ECMO.…”

Extracorporeal membranous oxygenation (ECMO) in polytrauma: what the radiologist needs to know

“…Recent advances in the biocompatibility of polymethylpentene gas exchange membranes, tipto-tip heparin bonding, and increased portability of miniaturized battery operated stand-alone systems have decreased the risk of clotting in the circuit, membrane-related hemolysis, and hemodilution from large priming volumes [4,5,[14][15][16][17][18][19][20]. High-flow vvECMO can now be used successfully without heparinization or restriction of blood coagulation support under careful monitoring with few thromboembolic complications [5,14,19,[21][22][23][24][25][26].…”

Safety and efficiency of recombinant activated factor VII in postcardiotomy massive hemorrhage

“…The use of rfVIIa has been reported in extracorporeal membrane oxygenation (17)(18)(19)(20) and left ventricular assist devices (21), but systemic and extracorporeal device thrombosis were observed (22). No randomized controlled trials are available to address the safety issue of rf-VIIa in extracorporeal support patients.…”

“…Nineteen per cent of their patients also had a complication that might have been caused by thromboembolism, namely, transient paraplegia and multiple organ failure, for a total of 44% of patients. Several case series (16)(17)(18)(19)(20) report no thromboembolic complications from rf-VIIa. Few series (14,15,23) address the safety of rf-VIIa in coronary artery bypass grafting surgery, with no adverse events reported.…”