Raivio Peter, Suojaranta-Ylinen Raili, Kuitunen Anne H
Department of Cardiothoracic Surgery, Helsinki University Hospital, Helsinki, Finland.
Ann Thorac Surg. 2005 Jul;80(1):66-71. doi: 10.1016/j.athoracsur.2005.02.044.
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.
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.
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.
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.
心脏手术后出现的与大量术后出血相关的全身性凝血障碍尚未完全明确。重组凝血因子VIIa（rFVIIa）已成为一种可能的“挽救性”药物。文献报道的经验有限，且担心可能出现血栓栓塞并发症，使得rFVIIa在心脏手术后出血治疗中的应用存在争议。
我们回顾性分析了赫尔辛基大学医院所有接受rFVIIa治疗的连续心脏手术患者，以评估rFVIIa在我院心脏手术后的安全性和有效性。通过手术室和重症监护病房（ICU）数据库共识别出16例患者。对患者记录以及手术室和ICU数据库进行了审查。
在这组高危患者中，医院死亡率较高（25%）。除3例患者（82%）外，所有患者在给予rFVIIa后均出现了明确的止血效果。给予rFVIIa后，平均出血量以及血小板和新鲜冰冻血浆的输注量均显著下降。4例患者出现了严重的术后血栓栓塞并发症。
重组凝血因子VIIa在恢复止血方面有效，但使用rFVIIa后出现了血栓栓塞并发症。它们可能与潜在的病理状况和所进行的手术有关。然而，rFVIIa治疗也有可能促使了这些并发症的发生。
