Utilization of recombinant activated factor VII for intracranial hematoma evacuation in coagulopathic nonhemophilic neurosurgical patients with normal international normalized ratios

McClelland, Shearwood; Won, Eun Kyung; Lam, Cornelius H.

doi:10.1007/s12028-007-0040-x

Cited by 8 publications

(4 citation statements)

References 22 publications

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“…Normal INR should not be a deterrent for patients to receive rFVIIa in the setting of strong neurosurgical suspicion for underlying clinical coagulopathy. [ 46 ] There is increased risk of intraoperative bleeding in patients who are on anticoagulants. There is also a risk of complications if anticoagulants are stopped in some patients.…”

Section: Treatmentmentioning

confidence: 99%

Chronic subdural hematoma

et al. 2016

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Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. There is lack of uniformity in the treatment of CSDH amongst surgeons in terms of various treatment strategies. Clinical presentation may vary from no symptoms to unconsciousness. CSDH is usually diagnosed by contrast-enhanced computed tomography scan. Magnetic resonance imaging (MRI) scan is more sensitive in the diagnosis of bilateral isodense CSDH, multiple loculations, intrahematoma membranes, fresh bleeding, hemolysis, and the size of capsule. Contrast-enhanced CT or MRI could detect associated primary or metastatic dural diseases. Although definite history of trauma could be obtained in a majority of cases, some cases may be secondary to coagulation defect, intracranial hypotension, use of anticoagulants and antiplatelet drugs, etc., Recurrent bleeding, increased exudates from outer membrane, and cerebrospinal fluid entrapment have been implicated in the enlargement of CSDH. Burr-hole evacuation is the treatment of choice for an uncomplicated CSDH. Most of the recent trials favor the use of drain to reduce recurrence rate. Craniotomy and twist drill craniostomy also play a role in the management. Dural biopsy should be taken, especially in recurrence and thick outer membrane. Nonsurgical management is reserved for asymptomatic or high operative risk patients. The steroids and angiotensin converting enzyme inhibitors may also play a role in the management. Single management strategy is not appropriate for all the cases of CSDH. Better understanding of the nature of the pathology, rational selection of an ideal treatment strategy for an individual patient, and identification of the merits and limitations of different surgical techniques could help in improving the prognosis.

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Section: Treatmentmentioning

confidence: 99%

Chronic subdural hematoma

et al. 2016

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“…В последующем было описано достаточно большое количество подобных наблюдений, в которых rFVIIa был эффективно использован у нейрохирургических больных с разными видами опухолей для восстановления гемостаза в ходе операций, осложнившихся массивной кровопотерей [77][78][79][80][81]. Эти наблюдения касаются и взрослых, и детей, но у детей, в особенности младшего возраста, ситуация всегда заведомо хуже из-за небольшго объема циркулирующей крови и, как следствие, быстрой декомпенсации системы гемостаза на фоне операционной кровопотери [80][81][82][83][84].…”

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The use of activated recombinant factor VII in neurosurgery

Lubnin

2018

Vopr. neirokhir.

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Список сокращений: ВМК-внутримозговое кровоизлияние КТ-компьютерная томография РКИ-рандомизированное контролируемое исследование САК-субарахноидальное кровотечение СМП-свежезамороженная плазма ЧМТ-черепно-мозговая травма

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“…Por último, pacientes con neoplasia extracraneal conocida, trombocitopenia, o trastornos de la hemostasia en cirugías previas, pueden ser susceptibles al desarrollo de coagulopatía, aún con un INR normal. En 2 de estos casos que requerían cirugía urgente se utilizó el aFVIIr con buen resultado de eficacia y funcional 94 . Cuestiones controvertidas en la terapia con aFVIIr a.…”

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“…Se podría recomendar su empleo una vez que fallan las medidas convencionales, pero sin que la demora haga que su eficacia se reduzca 10,77,94 . Para aumentar dicha eficacia, además de optimizarse el recuento plaquetario, el pH y la temperatura, debe intentarse mantener un hematocrito por encima de 24% y un nivel superior a 50 mg•dL -1 de fibrinógeno 86,88,148 .…”

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Rol del factor VII recombinante activado en pacientes neuroquirúrgicos y neurocríticos

et al. 2011

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ResumenLa hemorragia del sistema nervioso central constituye una patología grave, ya que un volumen de sangrado relativamente pequeño en el cerebro puede presentar consecuencias devastadoras. La utilización de agentes hemostáticos pueden reducir las consecuencias de la hemorragia cerebral espontánea, traumática o secundaria a la anticoagulación. El Factor VII recombinante activado (rFVIIa) es un fármaco procoagulante que se ha empleado en diversas patologías hemorrágicas del sistema nervioso central, si bien esta indicación no se recoge en la ficha técnica del fármaco. En esta revisión se repasa el mecanismo de actuación del fármaco, su potencial en el tratamiento de la hemorragia del sistema nervioso central y las evidencias existentes al respecto.Se realizó una revisión de la bibliografía disponible sobre el uso de rFVIIa en el control de la hemorragia relacionada con el sistema nervioso central, la patología neurocrítica y procedimientos neuroquirúrgicos, mediante búsqueda en MEDLINE y en el registro de ensayos clínicos: http://clinicaltrials.gov (última revisión septiembre 2010), además de revisión manual de las publicaciones a partir de la bibliografía de los artí-culos recuperados.En la hemorragia cerebral espontánea, existen ensayos clínicos aleatorios, cuyos resultados desaconsejan la utilización sistemática del fármaco en esta indicación. En el resto de hemorragias relacionadas con el sistema nervioso central, los datos existentes se basan en estudios retrospectivos, opiniones de expertos o casos clíni-cos aislados.PALABRAS CLAVE. Desórdenes de la coagulación. Hemorragia intracraneal. Factor VII recombinante activado. Cuidados críticos.The role of recombinant activated factor VII in neurosurgical and neurocritical patients Summary Central nervous system haemorrhage is a severe pathology, as a small amount of bleeding inside the brain can result in devastating consequences. Haemostatic agents might decrease the consequences of intracranial bleeding, whichever spontaneous, traumatic, or anticoagulation treatment etiology. Proacogulant recombinant activated factor VII (rFVIIa) has been given after central nervous system bleeding, with an off-label indication. In this update, we go over the drug mechanism of action, its role in the treatment of central nervous system haemorrhage and the published evidences regarding this subject.We carried out a literature review concerning the treatment with rFVIIa in central nervous system haemorrhage, neurocritical pathologies and neurosurgical procedures, searching in MEDLINE and in clinical trials registry: http://clinicaltrials.gov (last review September 2010), as well as performing a manual analysis of collected articles, looking for aditional references.The results of randomized clinical trials do not support the systematic administration of rFVIIa for spontaneous intracranial cerebral haemorrhage. In other central nervous system related haemorrhages, the current available data consist on retrospective studies, expert opinion or isolated case reports.KEY WORDS. Bloo...

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Utilization of recombinant activated factor VII for intracranial hematoma evacuation in coagulopathic nonhemophilic neurosurgical patients with normal international normalized ratios

Cited by 8 publications

References 22 publications

Chronic subdural hematoma

Chronic subdural hematoma

The use of activated recombinant factor VII in neurosurgery

Rol del factor VII recombinante activado en pacientes neuroquirúrgicos y neurocríticos

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