Factor VIII inhibitor bypass activity and recombinant activated factor vii in cardiac surgery

Vidya K. Rao, Robert L. Lobato, Blake Bartlett, Mark Klanjac, Christina T. Mora-Mangano, P. David Soran, Daryl A. Oakes, Charles C. Hill, Pieter J. Van Der Starre

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Design This retrospective study evaluated 168 patients who underwent cardiac surgery and received either FEIBA or rFVIIa to manage postbypass hemorrhage. Demographic, clinical, and outcomes data were collected and statistical analysis performed to compare thromboembolic event rates, relative efficacy, and 30-day mortality following administration of these medications.

Setting Single university hospital.

Participants Patients undergoing cardiac surgery.

Interventions None. Measurements and Main Result Sixty-one patients received rFVIIa, and 107 received FEIBA. Demographics, surgical procedures, and preoperative anticoagulation were similar between the cohorts; however, the rFVIIa cohort had longer durations of cardiopulmonary bypass (305.1 v 243.8 min, p<0.01). There were no significant differences in the number of thromboembolic events, 30-day mortality, or rates of revision surgery. Neither group demonstrated a clear relationship between dosage and occurrence of thromboembolic events. The rFVIIa cohort received more platelets than the FEIBA cohort (3.13 v 1.67 units, p = 0.01), but transfusion rates of other blood products were similar.

Conclusions This study suggests that rFVIIa and FEIBA have similar efficacy and adverse event profiles in managing intractable postbypass hemorrhage in cardiac surgical patients. Further prospective studies are required.

Objective Postcardiopulmonary bypass hemorrhage remains a serious complication of cardiac surgery. Given concerns regarding adverse effects of blood product transfusion and limited efficacy of current antifibrinolytics, procoagulant medications, including recombinant factor VIIa (rFVIIa) and factor eight inhibitor bypass activity (FEIBA), increasingly have been used in managing refractory bleeding. While effective, these medications are associated with thromboembolic complications. This study compared the efficacy and risk of adverse events of rFVIIa and FEIBA in cardiac surgical patients with refractory bleeding.

Original languageEnglish (US)
Pages (from-to)1221-1226
Number of pages6
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume28
Issue number5
DOIs
StatePublished - Oct 1 2014
Externally publishedYes

Keywords

  • cardiac anesthesia
  • cardiac surgery
  • cardiopulmonary bypass
  • coagulation transfusion
  • hemorrhage hemostasis
  • thromboembolic complications
  • transfusion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

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