Evaluating the efficacy of recombinant factor VIIa for non-surgical persistent bleeding in cardiovascular surgery: a...

Persistent bleeding after cardiovascular surgery challenges hemostatic management, especially in pediatric patients, but recombinant activated factor VIIa (rFVIIa), when used as a procoagulant, may improve patient outcomes.

We retrospectively evaluated 34 cardiac surgery patients who received recombinant rFVIIa for nonsurgical bleeding. Data on patient characteristics, surgical technique, rFVIIa administration, blood product use, complications, and hemostatic evaluation were collected. Red blood cell (RBC) transfusion volumes for 1 hour before and after rFVIIa administration were compared via a paired t-test.

Nineteen adult patients (mean age, 56.3 ± 15.3 years) and 15 pediatric patients [neonates (birth to 28 days), 7/15; infants (29 days to 1 year), 7/15; and preschoolers (3-6 years), 1/15] were included. RBC transfusion volumes were significantly reduced in adults (mean difference, 192.6 mL; 95% CI, 128.8-256.4 mL; P value < 0.001) and pediatric patients (mean difference, 37.0 mL/kg; 95% CI, 29.3-44.6 mL/kg; P value < 0.001) after rFVIIa. No thrombotic events were observed.

The need for blood transfusion during complex and emergency cardiac surgery was significantly reduced with rFVIIa administration, which was judged effective in the management of bleeding during cardiac surgery. Large-scale trials are needed to optimize its use in cardiac surgery.