Higher Incidence of Thromboembolic Events With the Use of Recombinant Activated Factor Vii During Placement of Left Ventricular Assist Device

Efficacy and Safety of Recombinant Factor VII as Rescue for Severe Perioperative Bleeding in HeartMate II Recipients

“…More recently Sultan et al reported on 65 HeartMate II and HeartWare patients, 20 of whom had received intraoperative rFVIIa. There was a higher rate of thromboembolic events in the rFVIIa group (30%) compared to the control group (15.9%) . The ability of rFVIIa to reduce transfusion of allogeneic blood products has a positive impact on outcome measures such as incidence of nosocomial infections, acute renal failure, cardiac complications, ventilator days, and length of hospital stay as shown by others .…”

“…There was a higher rate of thromboembolic events in the rFVIIa group (30%) compared to the control group (15.9%). 11 The ability of rFVIIa to reduce transfusion of allogeneic blood products has a positive impact on outcome measures such as incidence of nosocomial infections, acute renal failure, cardiac complications, ventilator days, and length of hospital stay as shown by others. [12][13][14][15] Furthermore, many LVAD patients are being bridged to transplantation and the additional sensitization of more transfusions may impact the potential for transplantation success.…”

Perioperative management of the bleeding patient

“…0.93 -1.58) and prophylactic use (RR 1.32; 95% CI 0.84 -2.06). 132 The overenthusiastic initial adoption of rFVIIa was subsequently tempered by thromboembolism complications. 130,132,133 We can apply this knowledge to PCC use in refractory bleeding by addressing substrate repletion and minimizing dosage (10-15 IU kg À 1 ; Figures 2 and 3).…”

“…132 The overenthusiastic initial adoption of rFVIIa was subsequently tempered by thromboembolism complications. 130,132,133 We can apply this knowledge to PCC use in refractory bleeding by addressing substrate repletion and minimizing dosage (10-15 IU kg À 1 ; Figures 2 and 3). Failure to address platelet, fibrinogen, Factors II, VIII, IX or X deficiencies in patients with severe haemorrhage can limit the effectiveness of rFVIIa or PCC to restore thrombin generation and fibrin clot formation.…”