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Rescue Therapy With Factor VII for Refractory Cardiac Surgical Bleeding: A Propensity-Score-Matched Study.

Victor M Neira1, Christian D Neira1, Kara Matheson2

  • 1Department of Anesthesia Perioperative Medicine and Pain Management, Dalhousie University, Halifax, Nova Scotia, B3H 2Y9, Canada.

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This summary is machine-generated.

Recombinant Factor VII activated (rFVIIa) effectively controlled bleeding in cardiac surgery but was associated with increased mortality and thromboembolism. This rescue therapy did not raise risks for stroke or renal failure.

Keywords:
Factor VIIbleedingcardiac surgeryrefractory

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Area of Science:

  • Cardiovascular Surgery
  • Hematology
  • Critical Care Medicine

Background:

  • Refractory bleeding after cardiac surgery poses significant risks.
  • Recombinant activated Factor VII (rFVIIa) is used as a rescue therapy for severe hemorrhage.
  • Understanding the effectiveness and safety profile of rFVIIa in this context is crucial.

Purpose of the Study:

  • To compare the effectiveness and safety of rFVIIa rescue therapy versus a propensity-score-matched control group.
  • To evaluate outcomes in adult patients undergoing cardiac surgery with cardiopulmonary bypass.

Main Methods:

  • Retrospective analysis of 8860 adult patients undergoing cardiac surgery (2009-2019).
  • Ninety-seven patients received rFVIIa and were propensity-score-matched 1:1 with controls.
  • Effectiveness assessed by coagulation tests, chest tube drainage, and reoperation rates; safety by morbi-mortality.

Main Results:

  • rFVIIa therapy was associated with lower postoperative INR but no significant difference in other bleeding parameters.
  • Higher rates of mortality (OR 3.17) and thromboembolism (OR 10.50) were observed in the rFVIIa group.
  • Increased blood product transfusion volumes were noted intraoperatively and postoperatively in the rFVIIa group.

Conclusions:

  • Rescue therapy with rFVIIa appears effective in controlling refractory bleeding during cardiac surgery.
  • However, rFVIIa use is associated with increased mortality, thromboembolic events, and transfusion requirements.
  • No significant association was found between rFVIIa and the risk of stroke or renal failure.