Use of Recombinant Factor VIIa to Correct the Coagulation Status of Individuals with Advanced Liver Disease Prior to a Percutaneous Liver Biopsy

Abstract

Recombinant factor VIIa could be used to obtain a clinically indicated liver biopsy in severely ill patients, who without this therapeutic agent, would either not be biopsied or, if biopsied, would require much longer hospitalization and the use of fresh-frozen plasma (with its risks of volume overload and infection).

Coagulation in hepatobiliary disease

“…A newer treatment option (although considered off‐label use) for coagulopathic human patients with hepatobiliary disease is administration of recombinant factor VIIa (rFVIIa). Human studies have shown rFVIIa can improve PT, but due to the extremely high cost of this therapy, it is unlikely to become a viable option for veterinary patients.…”

Clinical Usefulness of Recombinant Activated Factor VII in Patients with Liver Failure Undergoing Invasive Procedures

“…The Annals of Pharmacotherapy I 2011 November, Volume 45 I 1435 theannals.com 18 Advanced liver disease (n = 18); Liver disease-associated coagulopathy (n = 18), percutaneous liver biopsy therapeutic coagulopathy (n = 15) rFVIIa 100 µg/kg before biopsy Le (2010) 19 There were 74% of patients who achieved (within 10 minutes) and maintained (up to 18 hours) hemostasis after a single dose of rFVIIa. Of the remaining 17 patients, 13 required a second dose of rFVIIa 80 µg/kg following biopsy, at physicians' discretion.…”

Recombinant activated factor VII in patients with acute liver failure with UNOS Status 1A: a single tertiary academic centre experience

“…Thromboembolic complications are always a major concern with rFVIIa usage, especially in patients treated for off-label indications [14][15][16]. Up until now, although many studies demonstrated that rFVIIa could be helpful in patients with liver diseases undergoing invasive procedures or OLT, it is unclear whether rFVIIa is either superior or safer than conventional therapy (consisting of only blood products) in the subgroup of liver disease patients who have ALF [3,5,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. Therefore, given the paucity of published data and the lack of randomized controlled trials in this subgroup of patients with liver diseases, we retrospectively reviewed the use of rFVIIa in patients with ALF -United Network for Organ Sharing (UNOS) Status 1A (ALF-1A), to determine its efficacy and safety profile.…”