The use of recombinant activated factor viia in the management of post operative bleeding in cardiac surgery ; our experience at Queen Alia Heart Institute

Abstract EN

Objective : to describe our experience in the use of recombinant activated factor VII (Novoseven) in the management of post-operative bleeding in cardiac surgery at Queen Alia Heart Institute / King Hussein Medical Center-Jordan.

Methods : A simple descriptive study at Queen Alia Heart Institute between January2008 till December 2011 on a total of 160 patients who underwent open heart surgery and received recombinant activated factor VII (rf VIIa) was conducted.

A specially designed medical record abstract form was used to collect demographic, surgical and hematological data.

Simple descriptive statistics (mean, percentage, interquartile range) was used to describe the relevant data.

T-test was used also for determining bleeding, transfusion and coagulation profile before and after rf VIIa treatment.

P value was considered statistically significant if < 0.005.

Results : the rate of recombinant factor VIIa use was 0.02 % (number of patients received Novoseven / total number of operations carried out).

The mean dose of rf VIIa used was 65μg / kg where 152 patients (95 %) of the study group received single dose that stopped their bleeding.

A total of 135 (84 %) patients received their dose in the Intensive Care Unit while 25 patients (16 %) received their dose in the operating theater.

After the administration of recombinant factor VIIa it was clear that the amount of blood loss significantly decreased and the usage of the blood and its products was appreciably lower with the therapy than before it (p < 0.001).

Clinical outcome showed 4 deaths among patients received Novoseven (2.5 % mortality rate) although this was expected because of previous risky preoperative or intraoperative course.

None of our patients developed thromboembolic complications.

Conclusions : Recombinant Factor VIIa appears to be safe and effective in controlling nonsurgical life threatening bleeding in cardiac surgery.

It has been able to decrease the amount of blood loss, restoring hemostasis and reduce the need for further blood transfusion.