A Propensity-Score Matched Analysis on Outcomes Using Recombinant Activated Factor VII in Pediatric Cardiac Surgery

Objective: To evaluate the effect of recombinant activated factor VII (rFVIla) administration on outcomes in pediatric cardiac surgery patients with postoperative bleeding. Design: A propensity score-matched retrospective study. Setting: Single tertiary medical center. Participants: The study comprised 151 patients who received treatment with rFVIIa and were matched with control patients at a 1:2 ratio. Interventions: None. Measurements and Main Results: The primary endpoints were thrombotic events, renal replacement therapy (RRT), and mortality. The secondary endpoints were length of intensive care unit stay and the reexploration rate. Patients in the rFVIla group showed no significant differences in thrombotic events (odds ratio [OR] 1.03; 95% confidence interval [CI] 0.48-2.21; p = 0.948), mortality (OR 0.94; 95% CI 0.42-2.13; p = 0.891), and RRT (OR 1.38; 95% CI 0.73-2.58; p = 0.319). However, patients in the rFVIIa group experienced a prolonged length of intensive care unit stay (5.65 [3.00-12.28] d v 3.91 [1.83-6.77] d) and an increased reexploration rate (8.2% v 3.1%). High-dose rFVIla was an independent risk factor of thrombotic events (OR 5.17; 95% CI 1.19-22.49; p = 0.029). Conclusion: This study found that rFVIIa is not associated with increased risks of postoperative thrombotic events, mortality, or RRT in pediatric patients undergoing cardiac surgery. Nevertheless, rFVIIa was associated with longer intensive care unit stay and increased reexploration rate. Furthermore, the risk for thrombotic events may increase with high-dose rFVIIa. (C) 2019 Published by Elsevier Inc.