PURPOSE: Activated recombinant factor VII (FVIIa) (NovoSeven, NovoNordisk, Copenhagen, Denmark) is successful at controlling perioperative hemorrhage in hemophiliacs. Its efficacy in cardiac surgery, however, is less documented and has primarily been investigated as rescue therapy in patients with intractable coagulopathy despite conventional treatment with massive blood products. We proposed utilizing FVIIa as first line therapy in cardiac surgery patients with low platelet counts in an attempt to reduce blood product usage.
METHODS: Fourteen patients felt at risk to receive significant blood product transfusions following cardiac procedures utilizing cardiopulmonary bypass (CPB) were identified. Average preoperative platelet count was 65K (range 45-110). After terminating CPB, heparin was reversed with protamine and FVIIa (100mcg/kg) was administrated over 5 minutes.
RESULTS: No patients received platelets, fresh frozen plasma, or cryoprecipitate. Average post CPB platelet count was 44K (range 28-66K). Two patients each received two units packed red blood cells during CPB; average hematocrit at discharge was 26% (range 24-31%). Mean chest tube drainage was 690cc (range 200-1200cc). There were no reoperations for bleeding and no thrombotic complications were noted in any patient. Mean FVIIa dose was 7.0mg at an average cost of $7350 per patient.
CONCLUSION: FVIIa administered as first line therapy in patients with low platelet counts following cardiopulmonary bypass was safe and allowed surgery with minimal blood product usage.
CLINICAL IMPLICATIONS: Randomized trials using FVIIa are needed to standardize treatment and dosing regimens in order to better maximize the cost/benefit ratio.
DISCLOSURE: Keith Allen, None.