Probable right atrial thrombus immediately after recombinant activated factor VII administration.

Area of Science:

• Cardiology
• Hematology
• Trauma Surgery

Background:

• Severe trauma often leads to coagulopathy and hemodynamic instability.
• Recombinant activated factor VII (rFVIIa) is used to manage bleeding in such critical conditions.
• Continuous transesophageal echocardiography is a valuable tool for real-time cardiac assessment.

Observation:

• A 33-year-old male with severe multi-system trauma presented with refractory coagulopathy and hemodynamic instability.
• Following administration of recombinant activated factor VII (rFVIIa), a probable right atrial thrombus was visualized.
• The thrombus partially occluded the right ventricular inflow tract, appearing immediately post-rFVIIa infusion.

Findings:

• This is the first reported case demonstrating an immediate temporal association between rFVIIa administration and the formation of a space-occupying lesion consistent with localized thrombosis.
• The event occurred despite the patient's ongoing severe systemic coagulopathy.
• Echocardiography confirmed the presence and location of the suspected thrombus.

Implications:

• The findings suggest a potential risk of localized thrombosis formation secondary to rFVIIa administration, even in the context of systemic coagulopathy.
• Further investigation into the mechanisms and risk factors for rFVIIa-associated thrombosis is warranted.
• This case underscores the importance of vigilant monitoring for thrombotic events in critically ill patients receiving hemostatic agents.