Use of activated recombinant Factor VII (NovoSeven) during neurosurgery

Diffuse bleeding during neurosurgical operations is a major complication that can be difficult to control. In extreme circumstances, it may be necessary to clamp cerebral blood vessels or resect additional tissue. Both of these procedures can result in brain damage and, ultimately, in disability for the patient. We report on the use of recombinant activated blood coagulation Factor VII (rFVIIa) to control bleeding during neurosurgical procedures in three patients undergoing neurosurgery for brain tumors who received intravenous rFVIIa 4.8 mg (NovoSeven, NovoNordisk, Copenhagen, Denmark) for diffuse intracranial bleeding after conventional hemostatic techniques had been exhausted. All patients (one man and two women, age range 23-40 years) were otherwise somatically healthy with a mean weight of approximately 50 kg. Bleeding ceased 12 to 20 minutes after administration of rFVIIa. All three patients recovered with no further bleeding. In our initial experience, rFVIIa appears to be efficacious for terminating bleeding during neurosurgical procedures. The use of rFVIIa made it unnecessary to resort to procedures carrying a risk of long-term sequelae.