Activated recombinant factor VII after cardiopulmonary bypass reduces allogeneic transfusion in complex non-coronary cardiac surgery: randomized double-blind placebo-controlled pilot study.
Cardiac surgery is often associated with excessive blood component transfusion especially with complex and repeat procedures, and is therefore an obvious target for blood saving measures. There have been several previous case reports and small nonrandomized studies reporting efficacy and safety of rFVIIa in controlling severe intra- and postoperative bleeding with cardiac surgery, but this […]
Excellent article stressing the fact that transfusion safety today primarily has to improve safety regarding administration of blood in the clinics. Still focusing on safety of blood components may even draw away awareness and resources from these clinical problems which mean a significantly higher risk for the patients today. – Volker Kretschmer
A novel hemostatic agent: the potential role of recombinant activated factor VII (RFVIIa) in anesthetic practice.
This is an excellent literature review on the adjuvant use of rFVIIa in treating severe bleeding associated with surgical procedures in non-hemophiliac patients. It gives an overview of the mechanism of action of rFVIIa and its efficacy in patients with hemophilia, platelet dysfunction and liver disease. It also reviews its efficacy in managing bleeding in […]
Sequential treatment with bolus and continuous infusion of recombinant factor VIIa for hip arthroplasty in a patient with haemophilia A and inhibitor.
This is a case report on a hemophilia VIII patient with high titer inhibitor who underwent total hip replacement and treatment with rFVIIa. rFVIIa was given as bolus treatment for 5 days, followed by continuous infusion with reduced doses for 12 more days. The patient made excellent recovery. The authors claim that using rFVIIa in […]
Use of recombinant factor Vlla (NovoSeven((R))) to reduce postoperative bleeding after total hip arthroplasty in a patient with cirrhosis and thrombocytopenia.
The role of rFVIIa in improving hemostasis in patients with chronic liver disease and/or thrombocytopenia has been reported in many case reports. This article is reporting a 59 yr old woman with liver cirrhosis and thrombocytopenia who suffered with profuse bleeding post total hip replacement. The patient was receiving red cell reinfusion using a cell […]
This is a letter to the editor describing a 50 yr old woman who presented with pancreatitis but subsequently required laparatomy for pancreatectomy, splenectomy and subtotal gastrectomy. There was profuse bleeding which required massive transfusion support. Bleeding eventually dramatically responded to doses of rFVIIa at 120 μg/kg. – Maadh Aldouri
This is an editorial describing two case reports and a letter in that issue of Anesthesiology describing the effective use of rFVIIa during and after surgery to control bleeding which did not respond to standard therapy with transfusion of blood products. These patients were not known to have previous coagulopathy. The author, however, mentions that […]
Synthetic factor Vlla to treat dilutional coagulopathy during posterior spinal fusion in two children.
This is a case report on treating 2 children who had uncontrolled bleeding related to spinal fusion surgery in spite of treatment with aprotinin and FFP. Bleeding was controlled with two doses of rFVIIa (90 μg/kg)for each patient. It was also observed that coagulation parameters normalized after giving rFVIIa. The author concludes that this treatment […]
The novel HemoCue (R) Plasma/Low Hemoglobin System accurately measures small concentrations of three different hemoglobin-based oxygen carriers in plasma.
Clinical accuracy and reliability of the currently available Hemocue(R) B-Hemoglobin Photometer has been demonstrated for large concentrations of hemoglobin from human and bovine origin. Using a new version of the Hemocue(R), designed to measure smaller concentrations of hemoglobin, this in vitro study demonstrates that this system accurately measures plasma hemoglobin concentrations ranging from 0.065 to […]
Acute normovolaemic haemodilution beyond a haematocrit of 25%: ratio of skeletal muscle tissue oxygen tension and cardiac index is not maintained in the healthy dog.
This experimental study investigates the effects of stepwise acute normovolemic hemodilution on muscular oxygen delivery in healthy anesthetized dogs. – Philippe Van der Linden
Three cases of hemophilia A with inhibitors to factor VIII underwent total knee arthroplasty (TKA) using rFVIIa in the first patient, rFVIIa and high dose rFVIII in the second and porcine FVIII in the third patient with effective hemostasis. In case 1, a second TKA was managed with a high dose of rFVIIa (180 mg/kg) […]
The authors studied a database of 1,915 patients who underwent isolated first time myocardial revascularization between 1994 and 1997 and found that blood transfusions during or after coronary artery bypass operations were associated with increased long-term mortality (risk ratio = 1.7; 95% confidence interval = 1.4 to 2.0). This retrospective database analysis is important and […]
Influence of acid-citrate-dextrose anticoagulant on blood quality in retransfusion systems after total knee arthroplasty.
The authors propose to refrain from ACD anticoagulation in orthopedic postoperative autotransfusion. Their conclusion is not convincing. Products of activation of coagulation and fibrinolysis were not tested, although the main reason for anticoagulation is to decrease those dangerous contaminants. How can the authors justify to a patient with relevant blood loss the failure of the […]
Somewhat similar to the letter published by Cothren et al. in the NEJM, this article reports the case of a Jehovah’s witness who bled to a nadir hemoglobin concentration of 3.5 g/dL and was treated with 7 units of a bovine hemoglobin-based oxygen carrier and high-dose erythropoietin. No data are presented on oxygen transport variables, […]
This is a very important topic. All logical aspects would seem to suggest that stored cellular blood components have an immune suppressive effect. However, it is questionable whether this study can really document this effect. The difference in the number of transfused older blood units in the first 12 hours between the patients developing infectious […]