Overview on the use of recombinant factor VIIa in obstetrics and gynecology

Abstract

Bleeding remains a major cause of morbidity and mortality in obstetrics and gynecology. A unique drug, recombinant factor VIIa (rFVIIa), has been introduced recently for the management of surgical bleeding. This novel application of a drug that was restricted to hemophilia treatment for over 10 years has generated intense interest among surgeons. This article reviews the importance of bleeding in obstetrics and gynecology, the characteristics of this drug, including side effects, and all the evidence available on rFVIIa use in obstetrics and gynecology. Expert commentary on rFVIIa is presented with recommendations on its clinical application. rFVIIa is a fascinating adjunct therapy that is undergoing rapid and extensive investigation. rFVIIa has the potential to change the current standards of hemorrhage care in surgical patients, including obstetrics and gynecology patients.

Use of Recombinant Factor VIIa in Obstetrics

“…Their experience suggests that earlier drug administration may improve fertility outcomes and also avoid dilutional coagulopathy. Another large review of published case reports performed by Scarpelini et al 31 in 2007, examined 24 publications describing the use of rFVIIa in 56 patients. In 50 cases (89%) the drug was used in patients without pre-existing disorders of coagulation, with the most common pathology being PPH; bleeding related to gynaecological oncology surgery (for pelvic sarcoma, vaginal sarcoma and endometrial cancer) and congenital haematological disease.…”