Recombinant activated factor VII in the treatment of intractable non-surgical bleeding following major vascular procedures
| Autor: | Igor Koncar, Nebojsa Savic, Lazar Davidovic, Dusica Simic, Dejan Markovic, Radomir Sindjelic |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent lcsh:Medicine Factor VIIa Postoperative Hemorrhage vascular surgery Inferior vena cava Hemostatics law.invention Aortic aneurysm Randomized controlled trial law medicine.artery medicine Humans Myocardial infarction Child Vein intractablenon-surgical bleeding Aged Aorta recombinant activated factor VII (rFVIIa) business.industry lcsh:R General Medicine Middle Aged Vascular surgery medicine.disease Recombinant Proteins Surgery medicine.anatomical_structure medicine.vein Child Preschool Anesthesia cardiovascular system Portal hypertension Female business Vascular Surgical Procedures |
| Zdroj: | Srpski Arhiv za Celokupno Lekarstvo, Vol 136, Iss 7-8, Pp 367-372 (2008) |
| ISSN: | 2406-0895 0370-8179 |
| DOI: | 10.2298/sarh0808367k |
| Popis: | INTRODUCTION A recombinant form of activated factor VII (rFVIIa) is a haemostatic drug that is approved for use in haemophiliacs with antibodies to factor VIII or factor IX. Most recent studies and clinical experience have shown that rFVIIa (NovoSeven ?, Novo Nordisk A/S, Denmark) gives extreme haemostatic effect in patients with severe "non-haemophilic" bleeding produced after trauma and major surgery. OBJECTIVE We present our preliminary experience of the use of rFVIIa in vascular surgery when conventional haemostatic measures are inadequate. METHOD There were 32 patients divided into five groups: Group I - 14 patients with ruptured abdominal aortic aneurysms; Group II - 10 patients with thoracoabdominal aortic aneurysms; Group III - 5 patients with retroperitoneal tumors involving great abdominal vessels; Group IV - 2 patients with portal hypertension and Group V - one patient with iatrogenic injury of brachial artery and vein during fibrinolytic treatment, because of myocardial infarction. RESULTS Clinical improvement was detected following treatment in 29 patients. Bleeding was successfully controlled as evidenced by improved haemodynamic parameters and decreased inotropic and transfusion requirements. CONCLUSION In vascular patients more liberal use of rFVIIa is limited, because no randomized controlled trial has proved its efficacy and safety in such patients; while also keeping in mind that the price of a 4.8 mg of rFVIIa is $4,080. We recommend the use of rFVIIa in vascular surgery only during and after operative treatment of thoracoabdominal aortic aneurysms, ruptured abdominal aortic aneurysms, retroperitoneal tumors involving the aorta and/or inferior vena cava, as well as portal hypertension, when non-surgical massive uncontrolled bleeding are present. |
| Databáze: | OpenAIRE |
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