Recombinant factor VIIa corrects prothrombin time in cirrhotic patients: A preliminary study

Bernstein, DE; Jeffers, L; Erhardtsen, Elisabeth; Reddy, K. Rajender; Glazer, Steven; Squiban, Patrick; Bech, Rikke; Hedner, Ulla; Schiff, E.

doi:10.1016/s0016-5085(97)70013-1

Cited by 247 publications

(136 citation statements)

References 6 publications

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“…Bernstein et a 8 showed that rFVIIa is effective in transiently reversing the coagulopathy of cirrhosis at all three doses tested (5, 20, and 80 g/kg). Duration of response varied from 2 hours with the lowest dose (5 g/kg) to 12 hours with the highest dose (80 g/kg).…”

Section: Discussionmentioning

confidence: 97%

“…Patients in the rFVIIa group were administered 40 g/kg as an intravenous bolus. Our choice of this dose was derived from past hemophilia studies (in which 90 g/kg is typically administered), 12,13 early studies of cirrhotic patients (in which 5, 20, and 80 g/kg appeared to be effective), 8 and reports of patients with liver failure undergoing liver transplantation (in which 80 to 100 g/kg was administered). 9,14 Plasma administration was at the discretion of the attending physician in both groups of patients.…”

Section: Methodsmentioning

confidence: 99%

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Recombinant activated factor VII for coagulopathy in fulminant hepatic failure compared with conventional therapy

Shami

Caldwell

Hespenheide

et al. 2003

Liver Transplantation

218

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Severe coagulopathy in fulminant hepatic failure (FHF) is difficult to correct by conventional means. Recombinant activated factor VII (rFVIIa) is an antihemophilic factor that has shown promise in treating coagulopathy in liver disease. Our aim is to review our experience with rFVIIa in treating the coagulopathy of FHF and compare these results with those of conventional therapy. Fifteen patients with FHF who met King's College criteria for orthotopic liver transplantation were studied. All were ascertained from our liver disease registry. Eight consecutive patients were administered fresh frozen plasma (FFP) alone, whereas seven consecutive patients were administered FFP and rFVIIa (40 g/kg intravenous bolus). The two groups, with similar demographic characteristics, were compared in terms of measured parameters of coagulopathy (prothrombin time and international normalized ratio), amount of plasma infused, development of anasarca, ability to undergo intracranial pressure (ICP) transducer placement, bleeding complications, ability to undergo transplantation, and survival. All patients administered rFVIIa (after a single dose) versus none administered FFP alone had temporary (2-to 6-hour) correction of coagulopathy (P < .0002). All patients administered rFVIIa versus 38% administered FFP alone were able to have an ICP transducer placed (P ‫؍‬ .03). The rFVIIa group had less anasarca (P ‫؍‬ .04). An equal number of patients underwent transplantation from each group, but overall survival was slightly better in the rFVIIa group (P ‫؍‬ .04). Five of seven patients in the rFVIIa group were administered one or more subsequent doses of rFVIIa after placement of the ICP monitor (two patients, for additional procedures; three patients, prophylactically in the first 24 hours after ICP transducer placement) at the discretion of the attending physicians. We conclude that rFVIIa is effective in transiently correcting laboratory parameters of coagulopathy in patients with FHF. It facilitates the performance of invasive procedures and is associated with less frequent anasarca compared with conventional therapy. Our preliminary experience supports the need for further studies to define the optimal dosing, safety, and efficacy of rFVIIa in patients with FHF. (Liver Transpl 2003;9:138-143.)

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Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

Recombinant activated factor VII for coagulopathy in fulminant hepatic failure compared with conventional therapy

Shami

Caldwell

Hespenheide

et al. 2003

Liver Transplantation

218

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“…In patients with and without liver diseases, administration of rFVIIa shortened the abnormal PT value [119][120][121][122][123][124]. However, in randomized clinical trials rFVIIa administration to patients with cirrhosis proved ineffective in controlling bleeding from varices or bleeding during surgery [24,120,[125][126][127].…”

Section: Recombinant Activated Factor VIImentioning

confidence: 99%

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Andriulli

Tripodi

Angeli

et al. 2016

Digestive and Liver Disease

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a b s t r a c tPatients with cirrhosis present with hemostatic alterations secondary to reduced availability of procoagulant and anti-coagulant factors. The net effect of these changes is a rebalanced hemostatic system. The Italian Association of the Study of the Liver (AISF) and the Italian Society of Internal Medicine (SIMI) promoted a consensus conference on the hemostatic balance in patients with cirrhosis. The consensus process started with the review of the literature by a scientific board of experts and ended with a formal consensus meeting in Rome in December 2014. The statements were graded according to quality of evidence and strength of recommendations, and approved by an independent jury. The statements presented here highlight strengths and weaknesses of current laboratory tests to assess bleeding and thrombotic risk in cirrhotic patients, the pathophysiology of hemostatic perturbations in this condition, and outline the optimal management of bleeding and thrombosis in patients with liver cirrhosis.

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“…The intraoperative use of recombinant factor VIIa, which was shown to correct coagulation in cirrhotic patients [6], may in part substitute for fresh frozen plasma or other coagulation factors. Bypass avoidance and surgical portal decompression may also reduce intraoperative blood loss.…”

Section: Dear Editorsmentioning

confidence: 99%

Right lobe living-related liver transplantation in a Jehovah's Witness

Detry¹,

Roover²,

Kaba³

et al. 2002

Transplant International

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Recombinant factor VIIa corrects prothrombin time in cirrhotic patients: A preliminary study

Cited by 247 publications

References 6 publications

Recombinant activated factor VII for coagulopathy in fulminant hepatic failure compared with conventional therapy

Recombinant activated factor VII for coagulopathy in fulminant hepatic failure compared with conventional therapy

Hemostatic balance in patients with liver cirrhosis: Report of a consensus conference

Right lobe living-related liver transplantation in a Jehovah's Witness

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