Preoperative use of enoxaparin increases the risk of postoperative bleeding and re-exploration in cardiac surgery patients.
Interesting and important article; certainly of interest for practicing physicians. – Marcel Levi
Recombinant activated factor VII (NovoSeven): addition to replacement therapy in acute, uncontrolled and life-threatening bleeding.
Over the last seven years there has been increasing number of case reports and studies documenting the effectiveness and safety of using rFVIIa (NovoSeven) in treating non-hemophiliac patients with severe uncontrolled bleeding due to surgery or trauma. However, there is still no agreed protocol on when to use rFVIIa, the correct dose and which patients […]
This is an excellent and comprehensive review on the use of rFVIIa, its mechanism of action and various indications for its use in controlling bleeding in congenital and acquired coagulation disorders: factors VIII or IX deficiencies, oral vitamin K antagonists overdose, direct and indirect thrombin inhibitors, platelet disorders, and bleeding due to surgery or trauma. […]
The effects of a polymerized bovine-derived hemoglobin solution in a rabbit model of arterial thrombosis and bleeding.
Using a well recognized experimental model, the authors demonstrated that polymerized bovine-based hemoglobin solution markedly reduced arterial thrombosis rate and increased bleeding time in rabbits. These results are in contrast with those reported with other hemoglobin-based oxygen carriers. There is increasing evidence that the effects of hemoglobin solutions on hemostasis can be influenced by their […]
An assessment of the management of acute bleeding varices: a multicenter prospective member-based study.
The survey gives a good and very detailed overview about cause and current management of acute bleeding varices including rebleeding and lethality. However, no data except the amount of blood products is given about the indication and need of blood components as well as influence of therapy with blood components on outcome. In addition, no […]
This is an elegant paper which studied the hemostatic efficacy of different doses of rFVIIa and three of its analogs on controlling bleeding in mice with antibody induced hemophilia. There was significant decrease in blood loss, bleeding time, PT and APTT in the treated animals. rFVIIa analogs were 3-4 times more potent than rFVIIa, and […]
Increased local procoagulant action: a mechanism contributing to the favorable hemostatic effect of recombinant FVIIa in PLT disorders.
This paper reports the procoagulant effect of rFVIIa in experimental thrombocytopenia, and in thromboasthenic platelets due to natural or experimentally induced glycoprotein deficiency. It shows that rFVIIa improved fibrin deposition, thrombin generation and platelet interaction at sites of vascular damage. These observations may explain the hemostatic effects of rFVIIa in controlling hemorrhage in patients with […]
This is an interesting report on a small series of children with inherited platelet dysfunction treated with rFVIIa for acute bleeding or preoperatively. Response seemed to correlate with type of underlying condition, severity of bleeding and delay in presentation. In this series rFVIIa had variable efficacy in securing hemostasis. There was no difference in requirement […]
Effect of recombinant activated factor VII on perioperative blood loss in patients undergoing retropubic prostatectomy: a double-blind placebo-controlled randomised trial.
This is an interesting and important controlled study on using rFVIIa electively in the beginning of major surgery to reduce blood loss and blood transfusion. Patients were divided into three groups who received either placebo or rFVIIa at two doses: 20 μg/kg or 40 μg/kg. There was significant reduction in blood loss in the rFVIIa […]
Uncontrolled bleeding remains a major problem in intensive care and emergency medicine which still requires effective and innovative treatment options. This editorial highlights that there is growing evidence on the efficacy of rFVIIa (Novoseven) in controlling such bleeding, and that clinical trials in different patient populations are required to assess its efficacy and safety. – […]
This is another case report on the efficacy of Novoseven in controlling severe bleeding in cardiac surgery. Post-operative bleeding continued in spite of the use of blood products and aprotinin infusion, but stopped after a single dose of rFVIIa. Coronary catheterization performed after giving rFVIIa showed good aortic prosthetic function and no alteration in the […]
Case report on recombinant coagulation factor VIIa in the treatment of three haemophilia A patients with inhibitors in Singapore.
This is a first case report on using rFVIIa (Novoseven) to treat hemophilia patients with high response inhibitors to factor VIII in Singapore. The patients had bleeding with moderate severity, and it is noticeable that all of them responded very well to few doses and less amount of Novoseven than is usually recommended, due to […]
Influence of a new hydroxyethylstarch preparation (HES 130/ 0.4) on coagulation in cardiac surgical patients.
Note that volumes of Gelatine and Starch required to maintain CVP are no different between two groups, suggesting that the two solutions are equally effective as plasma volume expanders. However, study has little statistical power with regards to volumes of fluids administered, blood loss or blood/blood product usage. – M. Mythen.