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Ann Thorac Surg 2005;80:66-71
© 2005 The Society of Thoracic Surgeons
a Department of Cardiothoracic Surgery, Helsinki University Hospital, Helsinki, Finland
b Department of Anesthesia and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland
Accepted for publication February 15, 2005.
* Address reprint requests to Dr Raivio, Department of Cardiothoracic Surgery, Helsinki University Hospital, Haartmaninkatu 4, FIN-00029 HUS, Helsinki, Finland (Email: peter.raivio{at}hus.fi).
BACKGROUND: A generalized coagulation disorder after cardiac surgery that is associated with massive postoperative hemorrhage is not completely understood. Recombinant factor VIIa (rFVIIa) has emerged as a possible "salvage" medication. Limited experience reported in the literature and fears of possible thromboembolic complications make the use of rFVIIa in the treatment of bleeding after cardiac surgery controversial.
METHODS: We analyzed retrospectively all consecutive cardiac surgical patients who have received rFVIIa in the Helsinki University Hospital in order to evaluate the safety and efficacy of rFVIIa after cardiac surgery in our institution. Altogether, 16 patients were identified from operating room and intensive care unit (ICU) databases. Patient records and operating room and ICU databases were reviewed.
RESULTS: In this series of high risk patients hospital mortality was high (25%). A definite hemostatic effect was seen after rFVIIa administration in all but three patients (82%). Mean amount of bleeding and amount of platelet and fresh frozen plasma transfusions decreased significantly after rFVIIa administration. Four patients had serious postoperative thromboembolic complications.
CONCLUSIONS: Recombinant factor VIIa was effective in restoring hemostasis, but thromboembolic complications occurred after rFVIIa use. They may be related to the underlying pathologies and surgery performed. It is possible, however, that rFVIIa treatment contributed to their occurrence.
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