The aim of our study is to evaluate the advantages of using recombinant factor VII activated to improve hemostasis during surgery for empyema and to establish the optimal dose and moment of administration.
During 36 months (march 2002 - march 2005) we used recombinant factor VII activated in 34 patients who underwent major surgery for empyema: 26 patients with pleuro-pulmonary decortication (4 for overinfected posttraumatic hemothorax, 16 non-specific empyemas and 6 tuberculous empyemas) and 8 thoracopleuroplasties. A number of 10 decortications were performed in cirrhotic patients. Intraoperative findings and clinical criteria were used to evaluate the quality of hemostasis.
In all cases we achieved good hemostasis. We had no re-operation for hemostasis. There was a significant reduction of peri-operative blood losses and of transfused blood. Most patients required only small doses (1,2 - 2,4 mg/60 - 120 IU) administered at the beginning of the procedure. We encountered no side effects and only one postoperative death through sepsis in a patient with pulmonary gangrene.
Recombinant factor VII activated appears as an excellent hemostatic agent for diffuse bleeding during surgery for pleural empyema; it also improves closure of small aerian leaks and facilitates re-expansion of the lung.
Use of recombinant factor VII activated may improve the outcome of patients undergoing major surgery for pleural empyema. For a complete and correct evaluation, further prospective randomised studies are required.
Petre Botianu, None.