Franchini Massimo, Franchi Massimo, Bergamini Valentino, Montagnana Martina, Salvagno Gian Luca, Targher Giovanni, Lippi Giuseppe
Department of Pathology and Laboratory Medicine, University Hospital of Parma, Immunohematology and Transfusion Center, Parma, Italy.
Clin Obstet Gynecol. 2010 Mar;53(1):219-27. doi: 10.1097/GRF.0b013e3181cc4378.
Severe bleeding remains a leading cause of morbidity and mortality in obstetrics. The first-line standard treatment of massive postpartum hemorrhage (PPH) includes medical measures directed at improving uterine tone, replacement of lost intravascular volume, blood and coagulation factors, and surgical or invasive procedures. Recently, a number of case reports or case series have reported the successful "off-label" use of recombinant activated factor VII (rFVIIa) in PPH unresponsive to conventional treatments. In this review, a critical analysis of the published literature on the use of rFVIIa in severe PPH was performed. Overall, a total of 272 PPH women were collected among the largest case series and/or international registries. No randomized controlled trials have been conducted in this area. Currently, the literature data suggest that, at a median dose of 81.5 microg/kg, rFVIIa is effective in stopping or reducing bleeding in 85% of the cases. Finally, on the basis of the evidence from the literature and on own experience, we included some recommendations and an algorithm on the therapeutic role of rFVIIa in the management of PPH.
严重出血仍然是产科发病和死亡的主要原因。产后大出血（PPH）的一线标准治疗包括旨在改善子宫收缩力、补充丢失的血管内容量、血液和凝血因子的医学措施，以及手术或侵入性操作。最近，一些病例报告或病例系列报道了重组活化因子VII（rFVIIa）在对传统治疗无反应的PPH中成功的“超适应证”使用。在本综述中，对已发表的关于rFVIIa在严重PPH中应用的文献进行了批判性分析。总体而言，在最大的病例系列和/或国际登记处中总共收集了272例PPH妇女。该领域尚未进行随机对照试验。目前，文献数据表明，在中位剂量81.5微克/千克时，rFVIIa在85%的病例中可有效止血或减少出血。最后，基于文献证据和自身经验，我们纳入了一些关于rFVIIa在PPH管理中的治疗作用的建议和算法。
