PURPOSE: To review our clinical experience with intravenous recombinant activated factor VII (rFVIIa) in critically ill cancer patients with severe hemorrhage.
METHODS: Retrospective analysis of the medical records of all cancer patients who were treated with rFVIIa for severe hemorrhage and were admitted to the ICU at a tertiary care cancer center between January 2004 and December 2006. The following variables were collected: demographics, admitting service, severity of illness as measured by Mortality Probability Model II score (MPM-II) on ICU admission, use of vasopressors (VP) and mechanical ventilation (MV), source of hemorrhage, quantity of blood products transfused during the ICU stay, doses of rFVIIa administered, and ICU and hospital length of stay (LOS) and mortality.
RESULTS: Of 1390 patient admissions to the ICU during the 3-year period, 14 (1%) received rFVIIa for severe hemorrhage. The mean age was 49 years and 50% were male. Eight patients were medical cancer patients and 6 were postoperative surgical cancer patients. The mean MPM-II score was 38%. Seventy-nine percent of patients required MV and 36% received VP. The sources of hemorrhage were: multiorgan (n=3), hepatic (n=3), hemothorax (n=2), vascular (n=2), pulmonary (n=1), intracranial (n=1), gastrointestinal (n=1), and genitourinary (n=1). On average, patients received 10 units of red blood cells, 9 units of plasma, and 7 units of platelets. The average total dose of rFVIIa per patient was 36 mg and the average number of doses given was 7. Bleeding was controlled in 91% of patients. The mean ICU and hospital LOS were 15 and 32 days, respectively. The ICU mortality rate was 29% while the combined ICU and hospital mortality rate was 50%.
CONCLUSION: Recombinant factor VIIa was effective in controlling hemorrhage in a vast majority of critically ill cancer patients. However, the combined ICU and hospital mortality of these patients remained high.
CLINICAL IMPLICATIONS: The use of rFVIIa should be considered for the treatment of severe hemorrhage in cancer patients admitted to the ICU.
DISCLOSURE: Mohit Chawla, No Financial Disclosure Information; No Product/Research Disclosure Information