The Use of Recombinant Factor VIIa for Severe Intractable Bleeding During Spine Surgery

Abstract

Recombinant activated factor VII is promising as an adjunctive hemostatic agent for patients with perioperative bleeding problems during spine surgery. Efficacy is seen even at low doses.

The use of recombinant activated Factor VII in the control of haemorrhage following blunt pelvic trauma

“…A single dose of rFVIIa has also been successfully employed in the treatment of significant non‐surgical bleeding in a patient undergoing suprarenal abdominal aortic aneurysm repair [9]. A further series reports its successful use in four patients with intractable bleeding during spinal surgery, with a direct improvement in clotting profile and cessation of bleeding [10]. In eight cases of active haemorrhage from oesophageal varices, rFVIIa was used to achieve haemostasis where standard measures (pharmacotherapy and endoscopic techniques) were unsuccessful [11].…”

Efficacy and Safety of Recombinant Activated Factor VII in Major Surgical Procedures

“…Three successful case reports 6,9,16 where intractable bleeding was stopped after rFVIIa treatment are reported in kidney transplantation. In orthopedic surgery, there is 1 case report 28 and 1 RCT, where treatment with rFVIIa failed to reduce blood loss or transfusion requirements 47 in patients operated on for traumatic pelvis fracture.…”

“…1,2 In recent years, a consistent and growing number of studies and scientific publications have suggested many "off-label" indications for rFVIIa in bleeding disorders associated with surgical procedures in patients without any known congenital hemostasis or coagulation defects. The exis-tent literature is mainly composed of case reports [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] and case series [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] apparently describing a positive experience. Some retrospective studies with historical controls [36][37][38][39] and randomized controlled trials (RCTs) [40][41][42][43][44][45][46][47][48]…”