Recombinant factor VIIa in post-partum hemorrhage: A new weapon in obstetrician′s armamentarium

Abstract

Post-partum hemorrhage (PPH) is a life-threatening obstetric complication and the leading cause of maternal death. The usual manner for its management includes, first, noninvasive and nonsurgical methods, and, then invasive and surgical methods. However, mortality and morbidity related to PPH still remains unacceptably high, contributing to hysterectomy in at least 50% of cases. Early, effective, and preferably noninvasive treatments that can reduce maternal mortality and morbidity due to this entity are therefore essential. One of the most spectacular advancements in the control of PPH has been the use of recombinant activated factor (rFVIIa), both as initial and a life- and uterus-saving therapy. rFVIIa also reduces costs of therapy and use of blood components in massive PPH. In cases of intractable bleeding with no other obvious indications for hysterectomy, administration of rFVIIa should be considered before surgery. A MEDLINE search was done to review relevant articles in English literature on use of rFVIIa in PPH. Data were constructed and issues were reviewed from there. Our experience in a series of three cases of PPH, two of atonic and one of traumatic, successfully managed using rFVIIa is also shared.

Recombinant activated factor VII in post partum haemorrhage

“…Often, the patients are lost because too little is done too late. The review of the data available worldwide 14 15 16 and our own experience 17 18 shows that rFVIIa is an effective haemostatic agent. It is important that further studies be done and experiences shared worldwide on this seemingly effective drug, which has done an impressive journey in the last one dozen years and has the potential to help achieve MDG-5.…”

“… 14 15 16 There are no randomized controlled trials conducted, and for reasons that hardly require amplification, it is highly implausible that they will ever be performed in patients with life-threatening PPH. Our experiences in a series of five cases, two of atonic, one of traumatic and two with mixed PPH that were successfully managed using rFVIIa 17 18 has been shared first, followed by a discussion on the scope of rFVIIa in obstetric haemorrhage.…”

Role of intensive care in management of post-partum hemorrhage (PPH)

“…Its use is as a 'universal hemostasis ' and is explored in severe haemorrhage. 22 This experience has extended to severe postpartum hemorrhage and results have been encouraging 23 Recombinant factor VIIa, the recommended initial dose is 90 µg/kg, and a second dose can be given 20-60 minutes after the first dose if there is no response. RFVIIa has been used if conventional medical management fails and also when varying degrees of surgical management are unsuccessful, up to and including hysterectomy.…”

Strategies for blood conservation in pediatric cardiac surgery

“…Although not approved by FDA for control of postsurgery bleeding it has been used after obstetric and cardiac surgery to control refractory hemorrhage. [ 98 99 100 101 102 103 ] In addition to its, therapeutic role rFVIIa has also been used as a prophylactic agent to prevent excessive blood loss. [ 104 ] Before administering rFVIIa, the platelet count should be fair (50,000/µl) and any consumption coagulopathy should be ruled out.…”