Factor VIII Inhibitor Bypass Activity and Recombinant Activated Factor VII in Cardiac Surgery

Rao, Vidya K.; Lobato, Robert L.; Bartlett, Blake; Klanjac, Mark; Mora-Mangano, Christina; Soran, P.D.; Oakes, Daryl; Hill, Charles C.; Starre, Pieter J. van der

doi:10.1053/j.jvca.2014.04.015

Cited by 33 publications

(31 citation statements)

References 40 publications

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“…227 One retrospective study (n ¼ 168) has compared the efficacy of FEIBA and rFVIIa. 228 No significant difference was found between the two procoagulants in terms of morbidity and mortality. Platelet transfusion was higher among patients receiving rFVIIa, but no other differences in transfusion requirements were identified.…”

Section: Prothrombin Complex Concentratementioning

confidence: 93%

Management of severe perioperative bleeding

Kozek‐Langenecker

Ahmed

Afshari

et al. 2017

European Journal of Anaesthesiology

656

316

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: The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide healthcare professionals with an overview of the most recent evidence to help ensure improved clinical management of patients. For this update, electronic databases were searched without language restrictions from 2011 or 2012 (depending on the search) until 2015. These searches produced 18 334 articles. All articles were assessed and the existing 2013 guidelines were revised to take account of new evidence. This update includes revisions to existing recommendations with respect to the wording, or changes in the grade of recommendation, and also the addition of new recommendations. The final draft guideline was posted on the European Society of Anaesthesiology website for four weeks for review. All comments were collated and the guidelines were amended as appropriate. This publication reflects the output of this work.

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Section: Prothrombin Complex Concentratementioning

confidence: 93%

Management of severe perioperative bleeding

Kozek‐Langenecker

Ahmed

Afshari

et al. 2017

European Journal of Anaesthesiology

656

316

View full text Add to dashboard Cite

show abstract

“…There have been a few small retrospective studies examining the efficacy and safety of FEIBA in cardiac surgery. [56][57][58] Two of the studies using FEIBA as a rescue therapy, one involving 16 patients and the other involving 25 patients, found that after administration of FEIBA, the amount of FFP and platelets transfused decreased significantly. 56,57 The third study examined patients who received either FEIBA or recombinant activated factor VII (rFVIIa) and found that they have similar efficacy in controlling post-CPB bleeding.…”

Section: Prothrombin Complex Concentratesmentioning

confidence: 99%

Hemostatic Management of Extracorporeal Circuits Including Cardiopulmonary Bypass and Extracorporeal Membrane Oxygenation

Fang

Navaei

Hensch

et al. 2019

Semin Thromb Hemost

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Cardiopulmonary bypass and extracorporeal membrane oxygenation (ECMO) cause hemostatic derangements that can predispose patients to both bleeding and thrombotic complications. Often, patients present for urgent surgery while taking medications including antiplatelet agents, vitamin K antagonists, and direct oral anticoagulants, which must be recognized, monitored, and managed. During extracorporeal circulation, appropriate anticoagulation, most commonly with heparin, is required to maintain blood flow and avoid thrombotic complications. However, anticoagulation and other effects of extracorporeal circuits can also have an undesired consequence of bleeding. Extracorporeal circulation leads to coagulopathy that may require therapy with blood products such as platelets, cryoprecipitate, and plasma in case a patient bleeds. Platelet dysfunction related to exposure to a foreign circuit is a primary concern, as is the development of acquired von Willebrand syndrome, which frequently remains undetected on routine testing. Hemorrhagic complications in ECMO, such as intracranial hemorrhage, pulmonary hemorrhage, and hemithorax, can occur. Hemostatic agents including antifibrinolytics, desmopressin, fibrinogen concentrates, and other factor concentrates may be needed to achieve hemostasis in these often-challenging patients. Managing bleeding on extracorporeal support requires careful monitoring and a thoughtful approach.

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“…Use of rFVIIa was associated with an increased incidence of cerebral and bowel infarction, 54 and both rFVIIa and APCC showed similar risk of thromboembolic events (13.1% with rFVIIa and 12.1% with APCC), including cerebral infarction and pulmonary embolism in one post-CPB case series. 55 A more recent meta-analysis, however, did not show any increased risk of stroke with PCC, although the included studies were limited by sample size. 56 Taken together, the hemostatic efficacy of these procoagulants should be weighed against potential thrombotic risks individually.…”

Section: Discussionmentioning

confidence: 94%