Fatal outcome of recombinant factor VIIa in heart transplantation with extracorporeal membrane oxygenation.

Syburra T, Lachat M, Genoni M, Wilhelm MJ
Ann Thorac Surg 89(5):1643-1645.
NATA Rating :
Review by : W. Dietrich
NATA Review

This case report describes a fatal outcome after application of rFVIIa in combination with PCC in a bleeding patient after heart transplantation treated with ECMO. The patient was in desperate condition and suffered from a Candida sepsis, which was unrecognized preoperatively. Sepsis is a highly prothrombotic state. Several case reports report on thromboembolic complications with respect to rFVIIa and even controlled studies have reported these adverse events. Often, rFVIIa is a desperate, back-to-the-wall treatment. Thus, controlled trials are difficult or impossible to perform. However, the present case report is yet another warning to use rFVIIa cautiously in cardiac surgery.

– Wulf Dietrich

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