Effectiveness of the Recombinant Factor VIIa in Patients with the Coagulopathy of Advanced Child's B and C Cirrhosis

Abstract

Patients with advanced liver cirrhosis have a serious disturbance in their hemostasis system that leads to increased morbidity and mortality. The vitamin K-dependent clotting factors, especially factor VII, are markedly reduced in these patients. Present treatment modalities include fresh frozen plasma (FFP), vitamin K, and desmopressin. FFP has to be given in large volume and entails the risk of transmitting infectious agents. The introduction of recombinant activated factor VII (rFVIIa) has offered another treatment option for patients with liver cirrhosis and bleeding. The clinical experience with rFVIIa is reviewed. Management seems to be effective and safe and the concern that rFVIIa might activate the hemostasis system in these patients has not materialized. Administration of rFVIIa not only corrected the abnormal clotting tests in these patients but also allowed several invasive procedures without the complication of bleeding.

Mechanism of factor VIIa–dependent coagulation in hemophilia blood

“…[26][27][28][29][30][31][32][33][52][53][54][55][56][57][58][59] It has primarily been used to treat hemophilia patients with acquired inhibitors. [28][29][30][31][32] The in vivo concentrations of factor VIIa for this treatment range from 3 to 20 nM 29,60-63 (based on 50 000 units/mg specific activity of recombinant factor VIIa 63 ).…”

Use of Recombinant Factor VIIa to Correct the Coagulation Status of Individuals with Advanced Liver Disease Prior to a Percutaneous Liver Biopsy

“…These factors result in a substantial reduction in the costs associated with a prolonged hospital stay and coagulation monitoring as well as a marked reduction in time to accomplish a liver biopsy in patients requiring therapeutic anticoagulation. Several reports of the use of rFVIIa in patients undergoing liver biopsy have been reported previously [13][14][15][16][17][18]. Only a few of these reports included patients who would have been classified as being in Child's class C as was the case in this report.…”

A Cerebrovascular Event After Single-Dose Administration of Recombinant Factor VIIa in a Patient with Esophageal Variceal Bleeding

“…It was subsequently extended to the achievement of hemostasis in patients with uncontrolled bleeding in other clinical settings [9][10][11]. Bernstein et al reported that recombinant fVIIa corrected the prothrombin time in a dose-dependent manner in cirrhotic patients [6,7]. In addition to this, Jeffers et al showed that the administration of a single dose of factor VIIa was effective for cirrhotic patients, who were then able to undergo a laparoscopic liver biopsy without any bleeding complication [12].…”