Recombinant factor VIIa in the treatment of intractable bleeding in vascular surgery

Intractable bleeding unresponsive to conventional haemostatic measures is an uncommon but potentially life threatening surgical complication. Several studies have suggested that recombinant factor VIIa (rVIIa), a genetically engineered substitute for endogenous factor VIIa may have therapeutic application in patients with uncontrollable haemorrhage not previously diagnosed with coagulopathy. We report our experience of rVIIa use in eight such vascular surgery patients who developed life-threatening non-surgical haemorrhage either intra-operative or post-operatively. In all but one patient a marked clinical improvement was noted following treatment with rVIIa with significantly less transfusion, and obvious haemostasis associated with haemodynamic stability without adverse thrombotic complications.