Aortic dissection and hypothermic arrest in a Jehovah’s Witness patient: a case for recombinant factor VIIa?

Ballen, Jenifer; Raabe, Michael; Muirhead, Brian

doi:10.1007/bf03022498

Cited by 9 publications

(7 citation statements)

References 16 publications

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“…There are also isolated published 21 and unpublished (personal communication of panel members) reports of its prophylactic use in cardiac surgery. Both cardiac surgery RCTs were small, preliminary studies.…”

Section: Rationalementioning

confidence: 99%

The role of recombinant factor VIIa in on-pump cardiac surgery: Proceedings of the Canadian Consensus Conference

Karkouti

Beattie

Crowther

et al. 2007

Can J Anesth/J Can Anesth

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Purpose: Recombinant activated factor VII (rFVIIa) is currently not approved by Health Canada or the Food and Drug Administration for treating excessive blood loss in nonhemophiliac patients undergoing on-pump cardiac surgery, but is increasingly being used "off-label" for this indication. A Canadian Consensus Conference was convened to generate recommendations for rFVIIa use in on-pump cardiac surgery. Methods: The panel undertook a literature review of the use of rFVIIa in both cardiac and non-cardiac surgery. Appropriateness, timing, and dosage considerations were addressed for three cardiac surgery indications: prophylactic, routine, and rescue uses. Recommendations were based on evidence from the literature and derived by consensus following recognized grading procedures. Results: The panel recommended against prophylactic or routine use of rFVIIa, as there is no evidence at this time that the benefits of rFVIIa outweigh its potential risks compared with standard hemostatic therapies. On the other hand, the panel made a weak recommendation (grade 2C) for the use of rFVIIa (one to two doses of 35-70 µg·kg -1 ) as rescue therapy for blood loss that is refractory to standard hemostatic therapies, despite the lack of randomized controlled trial data for this indication. Conclusions: In cardiac surgery, the risks and benefits of rFVIIa are unclear, but current evidence suggests that its benefits may outweigh its risks for rescue therapy in selected patients. Methodologically rigorous studies are needed to clarify its riskbenefit profile in cardiac surgery patients. 200 Elizabeth Street, Toronto, Ontario M5G 2C4,; E-mail: keyvan.karkouti@uhn.on.ca Disclosure statement: Novo Nordisk (Mississauga, Ontario, Canada), the makers of rFVIIa, funded this project through an unrestricted educational grant. Novo Nordisk was not involved in the selection of the members of the consensus panel, nor were they involved in the panel's review process, deliberations, conclusions, or manuscript preparation. The panel's chair selected the panel members, with the objective of achieving relevant multi-disciplinary expertise (i.e., anesthesiology, cardiac surgery, hematology, intensive care, and clinical epidemiology). The manuscript was primarily written by the panel chair (Keyvan Karkouti) and was approved by all of the panel members. All of the authors received an honorarium for attending the consensus conference.

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Section: Rationalementioning

confidence: 99%

The role of recombinant factor VIIa in on-pump cardiac surgery: Proceedings of the Canadian Consensus Conference

Karkouti

Beattie

Crowther

et al. 2007

Can J Anesth/J Can Anesth

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“…Prophylactic use of rFVIIa during orthotopic liver transplantation was found to significantly reduce the number of patients requiring RBC transfusion, with no increase in thromboembolic events compared with placebo [9]. In addition, rFVIIa was used to manage hemostasis in a Jehovah's Witness [4]. …”

Section: Discussionmentioning

confidence: 99%

“…The use of rFVIIa as a prophylactic agent has been limited, because of concerns about the possibility of thrombosis and because of the high cost of rFVIIa. Thus, little is known about the prophylactic use of rFVIIa in patients undergoing surgery for an aortic hemorrhage [4]. We describe here the prophylactic use of rFVIIa in a patient undergoing hypothermic circulatory arrest and prolonged cardiopulmonary bypass for repair of a DeBakey type III aortic dissection.…”

mentioning

confidence: 99%

The prophylactic use of recombinant factor VIIa in a patient with DeBakey type III aortic dissection -A case report-

Kim

Son

et al. 2011

Korean J Anesthesiol

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“…4 Given the coagulopathy associated with moderate-to-deep hypothermia, few reports in Witnesses undergoing procedures involving this technique exist. 5,6 Herein, the successful use of hypothermic circulatory arrest for a redo sternotomy aortic procedure in a Jehovah's Witnesses patient through coordinated care among the surgeon, anesthesiologist, perfusionists, intensivists, and nurses using an established patient blood management (PBM) program is reported. The patient provided written consent for this case report.…”

mentioning

confidence: 99%

Successful Ascending Aorta and Hemiarch Replacement and Aortic Valve Resuspension Via Redo Median Sternotomy Using Hypothermic Circulatory Arrest in a Practicing Jehovah's Witnesses Patient

Gamble

Maxwell

Gaca

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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Aortic dissection and hypothermic arrest in a Jehovah’s Witness patient: a case for recombinant factor VIIa?

Cited by 9 publications

References 16 publications

The role of recombinant factor VIIa in on-pump cardiac surgery: Proceedings of the Canadian Consensus Conference

The role of recombinant factor VIIa in on-pump cardiac surgery: Proceedings of the Canadian Consensus Conference

The prophylactic use of recombinant factor VIIa in a patient with DeBakey type III aortic dissection -A case report-

Successful Ascending Aorta and Hemiarch Replacement and Aortic Valve Resuspension Via Redo Median Sternotomy Using Hypothermic Circulatory Arrest in a Practicing Jehovah's Witnesses Patient

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