Flower Oliver, Phillips Louise E, Cameron Peter, Gunn Kerry, Dunkley Scott, Watts Andrew, Rajbhandari Dorrilyn
Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Blood Coagul Fibrinolysis. 2010 Apr;21(3):207-15. doi: 10.1097/MBC.0b013e3283333589.
Recombinant factor VIIa (rFVIIa) is used in the treatment of life-threatening haemorrhage that is refractory to conventional treatment. The evidence supporting this practice in patients with liver disease is very limited. It has been used as a salvage therapy in end-stage liver disease (ESLD), in orthotopic liver transplant (OLT), other surgery, and upper gastrointestinal bleeding (UGIB) subpopulations. It has also been used prior to procedures in patients with ESLD. Data were collected by the Australia and New Zealand Haemostasis Registry (ANZHR) to perform a retrospective cohort study on the different subgroups of liver patients. This included 115 cases of use of rFVIIa in liver patients from 20 hospitals. A retrospective cohort study on the different subgroups of liver patients was performed. Main outcome measures were reduction or cessation of bleeding and 28-day mortality. Variables previously shown to predict response to bleeding after administration of rFVIIa were examined to determine whether correlations exist. Salvage therapy with rFVIIa was associated with reduction or cessation in bleeding in 24 of 36 OLT patients, 24 of 36 UGIB patients and 15 of 26 of other surgery patients. Clinical response to rFVIIa in OLT patients and other surgery patients was associated with a significantly lower mortality compared to nonresponders (P = 0.003 and 0.022, respectively). There was no relationship between mortality and bleeding response in patients with UGIB. Variables including acidosis, hypothermia, hypofibrinogenaemia, thrombocytopenia and Model of End-Stage Liver Disease (MELD) score were not associated with clinical response to rFVIIa. Five cases of use prior to procedures are described. Recombinant FVIIa is used as rescue therapy in surgical patients with ESLD and refractory haemorrhage in Australia and New Zealand. Traditional haemostasis variables were not associated with clinical response to rFVIIa in this cohort. Response to rFVIIa is associated with decreased mortality in ESLD patients undergoing OLT and other surgery, but not in UGIB.
重组凝血因子VIIa（rFVIIa）用于治疗对传统治疗无效的危及生命的出血。支持在肝病患者中使用这种疗法的证据非常有限。它已被用作终末期肝病（ESLD）、原位肝移植（OLT）、其他手术以及上消化道出血（UGIB）亚组患者的挽救治疗。它也在ESLD患者进行手术前使用。澳大利亚和新西兰止血登记处（ANZHR）收集了数据，以对肝病患者的不同亚组进行回顾性队列研究。这包括来自20家医院的115例肝病患者使用rFVIIa的病例。对肝病患者的不同亚组进行了回顾性队列研究。主要结局指标是出血减少或停止以及28天死亡率。检查了先前显示可预测rFVIIa给药后出血反应的变量，以确定是否存在相关性。rFVIIa挽救治疗使36例OLT患者中的24例、36例UGIB患者中的24例以及26例其他手术患者中的15例出血减少或停止。与无反应者相比，OLT患者和其他手术患者对rFVIIa的临床反应与死亡率显著降低相关（分别为P = 0.003和0.022）。UGIB患者的死亡率与出血反应之间没有关系。包括酸中毒、体温过低、纤维蛋白原血症、血小板减少症和终末期肝病模型（MELD）评分在内的变量与对rFVIIa的临床反应无关。描述了5例手术前使用的病例。在澳大利亚和新西兰，重组FVIIa被用作ESLD手术患者难治性出血的挽救治疗。在该队列中，传统止血变量与对rFVIIa的临床反应无关。对rFVIIa的反应与接受OLT和其他手术的ESLD患者死亡率降低相关，但与UGIB患者无关。
