Use of Recombinant FVIIa for Intraperitoneal Coagulopathic Bleeding in a Septic Patient
Abstract
Recombinant activated coagulation factor VII (rFVIIa) is a U.S. Food and Drug Administration (FDA)-approved drug for use in hemophiliacs with inhibitors.1 It has been safely utilized in this population of patients for over 13 years. rFVIIa functions by increasing local thrombin generation at sites where endothelium is damaged, resulting in increased platelet activation and aggregation and enhanced fibrin deposition.2 Because of its localized action at the site of endothelial damage, it is now being used in treating patients with an acquired coagulopathy.3 The emergency use of intravenous adjuncts for hemorrhage control, other than standard component therapy, has been largely ignored in the massively bleeding surgical patient.4 An injectable substance that would enhance normal clotting might reduce deaths from uncontrolled hemorrhage, decrease units transfused along with their complications, and reduce expense. Several drugs (estrogens and anti-fibrinolytic agents) have been utilized to decrease bleeding during elective surgery, but rFVIIa holds more promise.4 rFVIIa was originally isolated and later produced by recombinant technology to treat hemophilia patients with inhibitors to factors VIII and IX during critical bleeding episodes or major surgery.5 It also corrects the platelet defects associated with Glanzmanns thrombasthenia, Bernard Soulier syndrome, uremia, and other severe congenital and acquired thrombocytopathias.6-8 Furthermore, it has been shown to rapidly reverse coumadin anticoagulation in healthy volunteers and to correct prothrombin times in cirrhotic patients.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jul 01, 2003
- Accession Number
- ADA631633
Entities
People
- Craig F. Fischer
- Holly L. Neville
- John B Holcomb
- Keith Hoots
Organizations
- Uniformed Services University of the Health Sciences