Use of Low-Dose Recombinant Factor VIIa for Uncontrolled Perioperative Bleeding

Background: Recombinant activated factor VIIa (rFVIIa) is a prohemostatic agent initially approved for use in hemophilia patients and has also been used for a diverse range of off-label indications in the context of massive uncontrolled blood loss; however, no convincing evidence exists regarding the optimal dose of rFVIIa to treat uncontrolled bleeding in surgical patients. Aim: To evaluate the effects and safety of a very low dose of rFVIIa in patients with uncontrolled perioperative bleeding in the surgical intensive care unit (ICU). Methods: 55 patients from Beijing Hospital, who received rFVIIa between July 2004 and November 2018 for uncontrolled perioperative bleeding were included. The controls were matched for age, sex, severity, and operation type. The baseline demographics, survival, changes in bleeding and transfusion, coagulation parameters and complications were analyzed. Results: A low dose of rFVIIa (2.0*3.6 mg, with a median dose of 39.02 mg/kg) appears to be effective in controlling massive hemorrhage (with an effective rate of 74.55%), and can reduce volume of red blood cell transfusion, improve coagulation status, while has a relatively low risk of thromboembolic complications (3.6%). Conclusion: In patients with uncontrolled perioperative bleeding, a low dose of rFVIIa could be used when traditional methods are ineffective.