Washington University in Saint Louis School of Medicine, St. Louis, Missouri 63110, USA.
Anesthesiology. 2011 Dec;115(6):1201-8. doi: 10.1097/ALN.0b013e31821bdcfd.
Patients with amniotic fluid embolism (AFE) (major cardiac and pulmonary symptoms plus consumptive coagulopathy) have high circulating tissue factor concentrations. Recombinant factor VIIa (rVIIa) has been used to treat hemorrhage in AFE patients even though rVIIa can combine with circulating tissue factor and form intravascular clots. A systematic review was done of case reports from 2003 to 2009 of AFE patients with massive hemorrhage who were and were not treated with rVIIa to assess the thrombotic complication risk.
MEDLINE was searched for case reports of AFE patients receiving rVIIa (rVIIa cases) and of AFE patients who received surgery to control bleeding but no rVIIa (cohorts who did not receive rVIIa). Additional AFE case reports were obtained from the Food and Drug Administration, the Australian and New Zealand Haemostasis Registry, and scientific meeting abstracts. The risk of a negative outcome (permanent disability or death) in rVIIa cases versus cohorts who did not receive rVIIa was calculated using risk ratio and 95% confidence interval.
Sixteen rVIIa cases and 28 cohorts were identified who did not receive rVIIa. All patients had surgery to control bleeding. Death, permanent disability, and full recovery occurred in 8, 6, and 2 rVIIa cases and 7, 4, and 17 cohorts who did not receive rVIIa (risk ratio 2.2, 95% CI 1.4-3.7 for death or permanent disability vs. full recovery).
Recombinant factor VIIa cases had significantly worse outcomes than cohorts who did not receive rVIIa. It is recommended that rVIIa be used in AFE patients only when the hemorrhage cannot be stopped by massive blood component replacement.
羊水栓塞（AFE）（主要是心脏和肺部症状加上消耗性凝血障碍）患者的循环组织因子浓度较高。重组因子 VIIa（rVIIa）已被用于治疗 AFE 患者的出血，尽管 rVIIa 可以与循环组织因子结合并形成血管内血栓。对 2003 年至 2009 年期间接受 rVIIa 治疗的大量出血 AFE 患者和未接受 rVIIa 治疗的 AFE 患者的病例报告进行了系统评价，以评估血栓并发症风险。
在 MEDLINE 上搜索接受 rVIIa 治疗的 AFE 患者（rVIIa 病例）和接受手术控制出血但未接受 rVIIa 治疗的 AFE 患者（未接受 rVIIa 治疗的队列）的病例报告。还从食品和药物管理局、澳大利亚和新西兰止血登记处以及科学会议摘要中获得了其他 AFE 病例报告。使用风险比和 95%置信区间计算 rVIIa 病例与未接受 rVIIa 治疗的队列的不良结局（永久性残疾或死亡）的风险。
确定了 16 例 rVIIa 病例和 28 例未接受 rVIIa 治疗的队列。所有患者均接受手术控制出血。死亡、永久性残疾和完全恢复发生在 8 例、6 例和 2 例 rVIIa 病例和 7 例、4 例和 17 例未接受 rVIIa 治疗的队列中（死亡或永久性残疾与完全恢复的风险比为 2.2，95%CI 为 1.4-3.7）。
rVIIa 病例的结局明显差于未接受 rVIIa 治疗的队列。建议仅在大量血液成分替代无法止血时，才将 rVIIa 用于 AFE 患者。
