Barua Anupama, Rao Vinay P, Ramesh Bc, Barua Biplab, El-Shafei Hussain
Cardiothoracic Department, Nottingham City Hospital, Nottingham, UK;
J Blood Med. 2011;2:131-4. doi: 10.2147/JBM.S21609. Epub 2011 Sep 19.
Refractory post cardiopulmonary bypass (CPB) bleeding continues to cause concern for cardiac surgeons and intensivists. Massive postoperative hemorrhage following CPB is multifactorial and not fully understood, and it is also associated with increased mortality and morbidity. Activated recombinant factor VII (rFVIIa) has emerged as possible salvage medication in refractory post cardiac surgical bleeding. This observational study sought to identify the pattern of use of rFVIIa in cardiac surgery, its effectiveness, and risk.
This study involved a retrospective case review of medical records of ten patients undergoing a variety of cardiac surgery procedures and who developed life-threatening bleeding during surgery or after surgery despite conventional medical therapy, including transfusion of blood and blood products, and received rFVIIa at a regional center between August 2007 and April 2009.
All ten patients received two consecutive doses of rFVIIa (average dose 65 μg/kg) at a 2-hour interval. Eight patients were re-explored due to massive postoperative bleeding or cardiac tamponade before receiving rFVIIa. Surgical sources of bleeding were not identified in any cases. A second re-exploration was carried out in two cases. Two patients (20%) died in ITU from problems not related to bleeding and thromboembolism. Blood loss was significantly reduced after administration of rFVIIa. Blood loss 6 hours prior to treatment was 1758.5 ± 163.9 mL and blood loss in the 6-hour period post treatment was 405.6 ± 50.5 mL (P < 0.05). Blood and blood products used in the 6-hour period before and after administration of rFVIIa were 19.6 ± 1.5U and 4.4 ± 0.6U, respectively (P < 0.05). No adverse reactions or thrombotic complications related to rFVIIa were noted.
In our limited study, use of rFVIIa in refractory post surgical bleeding was significantly reduced blood loss and use of blood and blood products. We concluded that rFVIIa can be used satisfactorily and safely as a rescue therapy in the management of post cardiac surgical bleeding.
体外循环（CPB）后难治性出血一直是心脏外科医生和重症监护医生关注的问题。CPB术后大量出血是多因素导致的，目前尚未完全明确，且与死亡率和发病率增加相关。重组活化因子VII（rFVIIa）已成为心脏手术后难治性出血可能的挽救药物。本观察性研究旨在确定rFVIIa在心脏手术中的使用模式、有效性和风险。
本研究对10例接受各种心脏手术的患者的病历进行回顾性病例分析，这些患者在手术期间或术后尽管接受了包括输血和血液制品在内的传统治疗，但仍出现危及生命的出血，并于2007年8月至2009年4月在某地区中心接受了rFVIIa治疗。
所有10例患者均接受了连续两剂rFVIIa（平均剂量65μg/kg），间隔2小时。8例患者在接受rFVIIa之前因术后大量出血或心脏压塞而再次开胸探查。所有病例均未发现手术出血源。2例患者进行了第二次再次开胸探查。2例患者（20%）在重症监护病房因与出血和血栓栓塞无关的问题死亡。rFVIIa给药后失血量显著减少。治疗前6小时失血量为1758.5±163.9mL，治疗后6小时失血量为405.6±50.5mL（P<0.05）。rFVIIa给药前后6小时使用的血液和血液制品分别为19.6±1.5U和4.4±0.6U（P<0.05）。未观察到与rFVIIa相关的不良反应或血栓并发症。
在我们的有限研究中，rFVIIa用于难治性术后出血可显著减少失血量以及血液和血液制品的使用。我们得出结论，rFVIIa作为心脏手术后出血管理的挽救治疗方法，可以安全、满意地使用。
