Tzu Chi Medical Journal
Volume 19, Issue 4 , Pages 220-225, December 2007

Clinical Experiences with Recombinant Activated Factor VII for Managing Uncontrolled Hemorrhage in Non-Hemophilic Patients

  • Chi-Cheng Li

      Affiliations

    • Department of Oncology/Hematology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • Department of Oncology, Tzu Chi University, Hualien, Taiwan
    • ,
  • Ji-Hung Wang

      Affiliations

    • Department of Cardiovascular Disease, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • ,
  • Yen-Ta Huang

      Affiliations

    • Department of Medical Intensive Care Unit, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • ,
  • Han-Yu Huang

      Affiliations

    • Department of Medical Intensive Care Unit, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • ,
  • Tso-Fu Wang

      Affiliations

    • Department of Oncology/Hematology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • Department of Oncology, Tzu Chi University, Hualien, Taiwan
    • ,
  • Sung-Chao Chu

      Affiliations

    • Department of Oncology/Hematology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • Department of Oncology, Tzu Chi University, Hualien, Taiwan
    • ,
  • Chao-Yuan Yao

      Affiliations

    • Department of Oncology/Hematology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • Department of Oncology, Tzu Chi University, Hualien, Taiwan
    • ,
  • Yi-Feng Wu

      Affiliations

    • Department of Oncology/Hematology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • Department of Oncology, Tzu Chi University, Hualien, Taiwan
    • ,
  • Szu-Chin Li

      Affiliations

    • Department of Oncology/Hematology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • Department of Oncology, Tzu Chi University, Hualien, Taiwan
    • ,
  • Kuan-Po Huang

      Affiliations

    • Department of Oncology/Hematology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • Department of Oncology, Tzu Chi University, Hualien, Taiwan
    • ,
  • Wei-Han Huang

      Affiliations

    • Department of Oncology/Hematology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • Department of Oncology, Tzu Chi University, Hualien, Taiwan
    • ,
  • Ming-Ching Shen

      Affiliations

    • Department of Oncology/Hematology, Changhua Christian Hospital, Changhua, Taiwan
    • ,
  • Ruey-Ho Kao

      Affiliations

    • Department of Oncology/Hematology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
    • Department of Oncology, Tzu Chi University, Hualien, Taiwan
    • Corresponding Author InformationCorresponding author. Department of Oncology/Hematology, Buddhist Tzu Chi General Hospital, 707, Section 3, Chung-Yang Road, Hualien, Taiwan

Received 20 April 2007; received in revised form 8 May 2007; accepted 13 June 2007.

Article Outline

Abstract 

Objective

Recombinant activated factor VII (rFVIIa) is a novel hemostatic agent originally developed to treat hemophilia patients who had developed inhibitors with bleeding. Its role in treating uncontrolled bleeding in patients without pre-existing coagulation abnormalities has not been well established. We herein report our experiences with its use in non-hemophilic patients.

Patients and Methods

Four patients, aged 33 to 94 years, with different underlying diseases were treated with rFVIIa for uncontrolled, life-threatening hemorrhage. rFVIIa was initially administered by intravenous bolus injection at 80–100 mg/kg. Doses were adjusted according to clinical response.

Results

Clinical response with significant hemostasis was evident in three patients after initial treatment. One patient was unresponsive to rFVIIa treatment and died of uncontrolled bleeding. Of those who achieved initial hemostasis, two died of their underlying diseases. One had recurrent bleeding controlled by subsequent multiple doses of rFVIIa, but she died of acute myocardial infarction, a thromboembolic complication that probably arose from the use of rFVIIa.

Conclusion

Our results suggest that rFVIIa could play a role in the management of bleeding other than congenital coagulation disorder. However, clinical hemostatic effects that do not translate into a survival benefit require further study, especially with regard to appropriate timing for clinical use. Its potential risk, especially that of thromboembolism when treating bleeding in elderly patients, warrants further investigation.

keywords:  Hemophilia , Hemorrhage , Hemostasis , Recombinant factor VIIa (rFVIIa) , Thromboembolism

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PII: S1016-3190(10)60019-5

doi:10.1016/S1016-3190(10)60019-5

Tzu Chi Medical Journal
Volume 19, Issue 4 , Pages 220-225, December 2007

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