Recombinant Factor VIIa to Successfully Manage Disseminated Intravascular Coagulation From Amniotic Fluid Embolism

Prosper, Soumathy C.; Goudge, Christine S.; Lupo, Virginia R.

doi:10.1097/01.aog.0000235711.11817.8c

Cited by 29 publications

(18 citation statements)

References 7 publications

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“…Adjunctive therapy with tranexamic acid may be added to control excessive thrombolysis which may exacerbate the bleeding of DIC [19,20]. In extreme cases, when conventional therapy fails, anecdotal success has been reported with recombinant factor VIIa in patients with DIC and life-threatening bleeding [21,22]. However, the safety of this agent in the setting of DIC has not been studies [23].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Disseminated Intravascular Coagulation During Thoracolumbar Decompression in a Patient With Metastatic Carcinoma of the Prostate: Etiology, Diagnosis, and Treatment

Rafiq

Tobias

2015

J Med Cases

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Various factors may be responsible for disturbances of coagulation function during the perioperative period. Disseminated intravascular coagulation or coagulopathy (DIC) results from the widespread activation of the clotting cascade on the endothelial surface throughout the microvasculature that results in the formation of thrombin and fibrin. Although an uncommon cause of intraoperative bleeding, previous reports have noted the occurrence of DIC in association with adenocarcinoma of the prostate. We present a 62-year-old man with known metastatic carcinoma of prostate, who presented with rapidly progressing paraplegia and incontinence. During an emergent posterior thoracolumbar decompression and instrumentation, he developed excessive blood loss and DIC. The potential etiologies for intraoperative DIC are reviewed, the diagnosis is discussed, and perioperative management strategies are presented.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Disseminated Intravascular Coagulation During Thoracolumbar Decompression in a Patient With Metastatic Carcinoma of the Prostate: Etiology, Diagnosis, and Treatment

Rafiq

Tobias

2015

J Med Cases

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“…On the basis of some studies and individual reports, recombinant factor VIIa has been proposed for treatment of the coagulopathy associated with AFE (ref. 10,[37][38][39] ), although its efficacy is by no means established. Recombinant factor VIIa was used proportionately more frequently in Slovakia than in the UK; nevertheless the incidence of fatal AFE is higher in Slovakia.…”

Section: Discussionmentioning

confidence: 99%

Amniotic fluid embolism - Investigation of fatal cases in Slovakia in the years 2005-2010 compared with fatal cases in the United Kingdom

Krištúfková¹,

Borovský²,

Korbeľ³

et al. 2014

BIOMED PAP

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Background. Amniotic fluid embolism (AFE) is a rare, often severe complication of pregnancy. The clinical diagnosis is difficult to establish and is one of exclusion. The aim of this study was to investigate 6 fatal cases of AFE in Slovakia and compare the incidence, risk factors, course, management and neonatal outcomes with fatal cases of AFE in the United Kingdom (UK). Materials and Methods. Data on fatal cases of AFE in Slovakia were analysed and compared with fatal cases in the UK in the years 2005-2010. Results. The incidence in Slovakia was significantly higher than in the UK from 2005-2010 (RR 5.03, 95% CI 1.98-12.75, P=0.003). However, 5/6 deaths occurred in 2009 coinciding with the H1N1 flu virus pandemic in Slovakia. There were no significant differences in the characteristics of women who died, with the exception of gestational age at delivery; significantly higher in Slovakia (median 41 versus 39 weeks, P=0.01). In Slovakia most of the cases occurred after delivery, 83.3%, compared with 52.9% in the UK. There were no significant differences in clinical signs, use of recombinant factor VIIa or performance of obstetric hysterectomy. In Slovakia 83.3% and in the UK 94.7% of infants survived, but 20% and 27.8% had some long-term sequelae. Conclusion. AFE is now the leading cause of maternal deaths in Slovakia. However, we found no significant differences in the possible risk factors, course, management or outcomes between Slovakia and the UK. This analysis is limited by study power; we propose that establishment of a national register of cases of AFE in Slovakia would help further investigate and monitor mortality from this condition.Key words: amniotic fluid embolism, incidence of amniotic fluid embolism, risk factors of amniotic fluid embolism, maternal mortality, neonatal outcome by amniotic fluid embolism

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“…The cytological analysis was based on central or peripheral venous blood smear by using fresh hematoxylin-erosin (H-E) dropped stain examined by two pathologists. The examination revealed fetal squamous with background of maternal erythrocytes [5]. The diagnosis of pulmonary edema or adult respiratory distress syndrome (ARDS) was based on the clinical features including moist rales heard from both lung bases and blood gas analysis or chest X-ray.…”

Section: Methodsmentioning

confidence: 99%

“…If patient has no response to cardiopulmonary resuscitation, postmortem cesarean section can be performed during the resuscitation [18]. Total hysterectomy and/or iliac embolization or recombinant factor VIIa was made by a multidisciplinary team as other authors have reported [2,5,19] Recombinant factor VIIa has been used successfully to treat postpartum hemorrhage in patients who do not have high circulating tissue factor concentrations, such as those with uterine atony, uterine rupture, and abnormal placentation [19]. However, it is recommended that recombinant factor VIIa should be considered only in AFE patients when the hemorrhage cannot be stopped by massive blood component replacement.…”

Section: Arch Gynecol Obstetmentioning

confidence: 99%

From appearance to essence: 10 years review of atypical amniotic fluid embolism

Shen

Wang

Yang

et al. 2015

Arch Gynecol Obstet

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Staying alert to premonitory symptoms of AFE is critical to turn it to a remediable disease. Patient complaints such as breathlessness, chest pain, feeling cold, distress, panic, a feeling of nausea, and vomiting should elicit close attention. The management of a suspected episode of amniotic fluid embolism is generally considered to be supportive. Hysterectomy must be performed if there is further progression of symptoms. Due to advances in acute care, mortality has decreased in recent years, highlighting the importance of early detection and treatment.

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Recombinant Factor VIIa to Successfully Manage Disseminated Intravascular Coagulation From Amniotic Fluid Embolism

Cited by 29 publications

References 7 publications

Intraoperative Disseminated Intravascular Coagulation During Thoracolumbar Decompression in a Patient With Metastatic Carcinoma of the Prostate: Etiology, Diagnosis, and Treatment

Intraoperative Disseminated Intravascular Coagulation During Thoracolumbar Decompression in a Patient With Metastatic Carcinoma of the Prostate: Etiology, Diagnosis, and Treatment

Amniotic fluid embolism - Investigation of fatal cases in Slovakia in the years 2005-2010 compared with fatal cases in the United Kingdom

From appearance to essence: 10 years review of atypical amniotic fluid embolism

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