Anesthesia & Pain Research


Timing of Recombinant Factor VIIa Administration for Severe Bleeding in Cardiac Surgery: Does It Make Any Differences?

Abdalla M, Ewila H, Eissa M, AL Khulaifi A, Singh R.

Introduction: Perioperative severe bleeding remains a frequent complication in cardiac surgery with high incidence of morbidity and mortality. Recombinant activated factor VII (rVIIa) is administered for the management of many cases of severe bleeding in cardiac surgery with improvement of outcome. We hypothesize that there may be differences in the efficacy and safety of early versus late administration of rVIIa.

Methods: A retrospective descriptive analytic study involved all patients who received rFVIIa in cardiac surgery department over 6 year’s duration with a total number of 50 patients. The studied population was divided into two groups according to timing of rFVIIa administration, early group who received rVIIa within the first 2 hours of onset of bleeding (23 patients) and late group if rVIIa was given after 2hours of onset of bleeding (27 patients). Preoperative, intraoperative and postoperative data were collected and statistically analyzed.

Results: There were no significant statistical demographic or surgical differences between the identified groups. Postoperatively we noted statistically significant lower postoperative blood loss (p =.001), blood transfusion (p=.02), Fresh frozen plasma P (p= .02), platelets transfusion (p= .02) and incidence of re-exploration (p=.02) in the early rVIIa administration group. There was no difference in the lengths of mechanical ventilation or hospital stay but length of ICU stay was significantly longer in the late rVIIa administration group.

Conclusion: In this analysis, Early administration of rFVIIa in the management of severe bleeding following cardiac surgery was associated with decreased blood loss, decreased the need for blood and blood products transfusion and decreased Incidence of Re-exploration. Long-term safety remains unclear.

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