Off-label use of recombinant factor VIIA concentrates after cardiac surgery.

This article reviews the mechanism of action of rFVIIa and outlines its off-label use in management of perioperative bleeding and intracranial hemorrhage.

Authors review the paper of Raivio et al on use of rFVIIa in cardiac surgery which confirms efficacy in controlling severe hemorrhage, as previously reported in several case reports, but highlights the increased occurrence of thrombotic episodes, probably due to the nature of cardiac surgery itself. Risk factors for thrombosis include hemostatic activation by extracorporeal circulation, reduction of physiologic anticoagulants such as antithrombin, proteins C and S, use of antithrombotic medications and existing vascular disease. The review suggests restricting use of rFVIIa to severe uncontrolled non-surgical bleeding where conventional supportive fails to control bleeding.

– Maadh Aldouri