The potential role of recombinant activated FVII in the management of critical hemato-oncological bleeding: a systematic review

Successful Control of Massive Gastrointestinal Bleeding Following Umbilical Cord Blood Transplantation (Ucbt) by Use of Recombinant Activated Factor Vii (Rfviia) and Octreotide Infusion

“…This case supports the conclusion of systematic review by Franchini et al [8] regarding the usefulness of rFVIIa in HSCT. Following this case,we suggest that rFVIIa with octerotide be considered as an additional mode of therapy for life-threatening GI bleeding post HSCT in the face of severe thrombocytopenia and platelet refractoriness, where platelet transfusions and other haemostatic agents have failed.…”

“…We could find five more reports (one randomised trial and four case reports) regarding use of rFVIIa in GI bleeding postallogenic BMT (Table 1) in the published literature [8]. In these reports total 8 patients had severe lower GI bleed, out of which 2 patients had complete response, 3 had partial response and 3 had no response to rFVIIa.…”

“…These measures may not always be successful in controlling severe bleeding, and surgical and endoscopic interventions may be needed. rFVIIa, initially shown to be efficacious in patients with hemophilia A with inhibitors, has since been used to secure hemostasis in thrombocytopathies and other life threatening situations [8,[11][12][13]. The exact mechanism of action is not known, but it is likely that rFVIIa results in the localised generation of thrombin on the platelet surface resulting in platelet activation, with subsequent activation of Factor X leading to the formation of a hemostatic plug.…”

“…Franchini et al, in a systematic review on the potential role of recombinant activated FVII in the management of critical hemato-oncological bleeding collected a total of 13 articles in the literature including 113 BMT patients treated with rFVIIa. Gastrointestinal bleeding was the leading cause of hemorrhage (46.9%), followed by hemorrhagic cystitis (31.8%) and diffuse alveolar hemorrhage (13.3%).Response in terms of cessation or significant reduction of bleeding was observed in the majority of patients (69/ 113, 61.1%) [8]. Eroglu has reported a response rate of 50% to octreotide in gastrointestinal bleeding in patients without portal hypertension [9].…”

7 Procoagulators

“…The mean single dose was observed to be just under 90 µg/kg body weight. A recent review article [23] states that bleeding has been halted in many patients following the first injection.…”