Factor VIIa in Puerperal Hemorrhage With Disseminated Intravascular Coagulation

Pepas, Litha; Arif-Adib, Merhnoosh; Kadir, Rezan A.

doi:10.1097/01.aog.0000197064.44340.d4

Cited by 32 publications

(16 citation statements)

References 9 publications

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“…This case series documents a clinical response (bleeding stopped or decreased) to rFVIIa in 80% of patients, which is comparable to previous documented clinical response rates described in case reports and small series in obstetric haemorrhage [9][10][11][12][13][14][15]. It is also comparable to the response to rFVIIa reported in life-threatening haemorrhage from all causes, where the median response rate is reported as 74% [2][3][4][5][6][7][8].…”

Section: Discussionsupporting

confidence: 85%

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Recombinant Activated Factor VII as a Second Line Treatment for Postpartum Hemorrhage

Park

Yeom²,

Han

et al. 2017

Korean J Crit Care Med

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BackgroundSevere or massive postpartum hemorrhage (PPH) has remained a leading cause of maternal mortality for decades across the world and it results in critical obstetric complications. Recombinant activated factor VII (rFVIIa) has emerged as a gold standard adjunctive hemostatic agent for the treatment of life-threatening PPH refractory to conventional therapies although it remains off-licensed for use in PPH. We studied the effects of rFVIIa on coagulopathy, transfusion volume, prognosis, severity change in Korean PPH patients.MethodsA retrospective review of medical records between December 2008 and March 2011 indicating use of rFVIIa in severe PPH was performed. We compared age, rFVIIa treatment, transfusion volume, and Sequential Organ Failure Assessment (SOFA) score at the time of arrival in the emergency department and after 24 hours for patients whose SOFA score was 8 points or higher.ResultsFifteen women with SOFA score of 8 and above participated in this study and eight received rFVIIa administration whereas seven did not. Patients’ mean age was 31.7 ± 7.5 years. There was no statistically significant difference in initial and post-24 hours SOFA scores between patients administered rFVIIa or not. The change in SOFA score between initial presentation and after 24 hours was significantly reduced after rFVIIa administration (P = 0.016).ConclusionsThis analysis aimed to support that the administration of rFVIIa can reduce the severity of life-threatening PPH in patients. A rapid decision regarding the administration of rFVIIa is needed for a more favorable outcome in severe PPH patients for whom there is no effective standard treatment.

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Section: Discussionsupporting

confidence: 85%

“…There are several published case reports and small case series documenting the effective use of rFVIIa in the management of major obstetric haemorrhage [9][10][11][12][13][14][15]. However, large case series and randomised controlled trials have not been conducted.…”

Section: Introductionmentioning

confidence: 99%

Recombinant Activated Factor VII as a Second Line Treatment for Postpartum Hemorrhage

Park

Yeom²,

Han

et al. 2017

Korean J Crit Care Med

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“…Our data suggest that a single dose of 70 µ g/kg may be suffi cient in most cases to control severe PPH in agreement with previous literature reviews [24] . According to consensus recommendations for the off-label use of recombinant factor VIIa therapy [27] a mean dosage of 71 µ g/kg was capable to arrest bleeding with the lowest dosage of 36 µ g/kg bodyweight.…”

Section: Commentsupporting

confidence: 92%

“…In postpartum hemorrhage, the use of this conservative treatment option has been described previously. However, to date, only case reports and small case series describing the rhFVIIa use in postpartum hemorrhage have been reported; in most cases, it was used only after postpartum hysterectomy [1,4,7,24,26] . The results of two registries (Northern European [3] and Australian New Zealand [25] ) had included larger series; however, these are collected data from many different centers with different inclusion criteria and different management strategies of postpartum hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

Recombinant human factor VIIa prevents hysterectomy in severe postpartum hemorrhage: single center study

Huber

Raio

Alberio

et al. 2012

Journal of Perinatal Medicine

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Objective: To evaluate the effectiveness of human recombinant activated factor VII (rhFVIIa, NovoSeven) in avoiding hysterectomy postpartum in the management of severe postpartum hemorrhage (PPH). Methods: We performed a prospective cohort study at our university tertiary care center. Patients with severe post partum hemorrhage (blood loss > 2000 mL) and failed medical and uterus-preserving surgical management, were treated with intravenous bolus administration of rhVIIa. Main outcome measures were cessation of bleeding, postpartum hysterectomy and thromboembolic events. Results: In 20/22 patients included, PPH was caused primarily by uterine atony, including 7 (32 % ) with additional lower genital tract lesion; in two women, it was due to pathologic placentation (placenta increta, 9 % ). One case of amniotic fl uid embolism and one woman with uterine inversion were included. Recombinant hFVIIa was successful in stopping the PPH and in preventing a hysterectomy in 20/22 women (91 % ). The remaining two patients with persistent bleeding despite rhFVIIa treatment, who underwent postpartum hysterectomy, had placenta increta. No thromboembolic event was noticed. Conclusions: This study describes the largest single center series of rhFVIIa treatment for fertility preservation in severe postpartum hemorrhage published to date. Our data suggest that administration of rhFVIIa is effective in avoiding postpartum hysterectomy after conservative medical and surgical measures have failed. Although randomized studies are lacking, rhFVIIa should be considered as a second-line therapeutic option of life-threatening postpartal bleeding, in particular if preservation of fertility is warranted and hysterectomy is to be avoided.

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“…(Aggarwal et al, 2004;Ahonen & Jokela, 2005;Ahonen et al, 2007;Boehlen et al, 2004;Bomken et al, 2009;Bouwmeester et al, 2003;Boyer-Neumann et al, 2003;Brueckner et. al., 2001;Dart et al, 2004;Dutton et al, 2004;Eikelboom et al, 2003;Franchini et al, 2007;Franchini et al, 2008;Hollnberger et al, 2005;Holub et al, 2005;Jansen et al, 2005;Jimenez-Yuste et al, 2000;Kale et al, 2004;Kretzschmar et al, 2003;Macphail et al, 2004;Martinowitz & Michaelson, 2005;Mayo et al, 2004;Merchant et al, 2004;Mittal & Watson, 2006;Moscardo et al, 2001;Mousa & Walkinshaw, 2001;Mousa & Alfirevic, 2003,2007Nowacka et al, 2005;Palomino et al, 2006;Pepas et al, 2006;Price et al, 2004;Segal et al, 2004;Shamsi et al, 2005;Shander et al, 2005;Sobieszczyk et al, 2002Sobieszczyk et al, , 2004Sokolic et al, 2002;Tanchev et al, 2005;Verre et al, 2006;Vincent et al, 2006;Welsh et al, 2008;…”

Section: World Experience Of Use Of Rfviia In Treatment Of Pphunclassified