Article description

Summary:

• Recombinant activated factor VIIa (rVIIa) is used off-label for refractory bleeding after cardiac surgery in children
• A single center, retrospective case-control observational study, done at an Australian quaternary pediatric hospital over a three year period
• Administration of rVIIa as rescue therapy for refractory bleeding after weaning from cardiopulmonary bypass and
• Indications, usage rates, and complications of rVIIa was studied retrospectively

Measurements and Main Results

• N=1515 cardiopulmonary bypass procedures were reviewed
• Patients (n-42, 2.8% of patients) receiving rVIIa were each matched to two control patients by age, procedure type, and bypass time
• The following data was collected: Weight, cross clamp time, anticoagulant and antifibrinolytic dose, return to the operating room for bleeding, thrombotic events, and extracorporeal membrane oxygenation (ECMO) circuit interventions
• Major systemic thrombotic complications were observed in 19% of patients vs. 12.5% controls
• Important to note: 80% of recombinant factor VIIa patients requiring postoperative ECMO had interventions for circuit thrombosis (controls 31.25%)
• Re-exploration for intractable bleeding was necessary in 4.76% of the rVIIa recipients vs. in 1.39% of controls

Summary: (copied from article)

Conclusion

This study added to understanding regarding the use of recombinant factor VIIa in pediatric cardiac surgery and reported increased thrombotic complications, especially for children who progress to ECMO.

Prospective studies to better understand the pathophysiology of coagulopathy and hemorrhage in pediatric cardiac surgery and the role of hemostatic agents, such as rVIIa, are required.

Certainly, care should be taken in the administration of rVIIa