Department of Anesthesia, Women's Clinic, Helsinki University Hospital, Helsinki, Finland.
Curr Opin Anaesthesiol. 2012 Jun;25(3):309-14. doi: 10.1097/ACO.0b013e3283532007.
To review the literature regarding the use of recombinant activated factor FVII (rFVIIa) in the treatment of postpartum hemorrhage (PPH).
The previous and recent case reports and case series suggest a potential benefit of rFVIIa in the management of severe PPH refractory to standard treatment. However, the lack of randomized controlled studies limits the value of the available data. rFVIIa cannot work optimally if there is a shortage of the basic components of the coagulation cascade such as fibrinogen. New experimental data suggest that rFVIIa can relocate into the extravascular space and remain functionally active which may prolong its hemostatic effect longer than the short circulatory half-life indicates.
Although some preliminary guidelines have been published, the case reports and case series illustrate that the practice of using rFVIIa in PPH is far from uniform. rFVIIa should usually not be used to compensate for an inadequate transfusion therapy. Therefore, early and effective administration of red blood cells, fresh frozen plasma, fibrinogen concentrate (or cryoprecipitate), and platelets as well as the control of uterine atony are essential before considering administration of rFVIIa in the treatment of PPH.
回顾关于重组激活因子 VII（rFVIIa）治疗产后出血（PPH）的文献。
先前和最近的病例报告和病例系列研究表明，rFVIIa 在治疗对标准治疗无效的严重 PPH 方面可能具有潜在益处。然而，缺乏随机对照研究限制了现有数据的价值。如果纤维蛋白原等凝血级联的基本成分缺乏，rFVIIa 就不能发挥最佳作用。新的实验数据表明，rFVIIa 可以重新定位到血管外空间并保持功能活性，这可能使其止血效果延长超过其短循环半衰期所表明的时间。
尽管已经发布了一些初步指南，但病例报告和病例系列研究表明，rFVIIa 在 PPH 中的使用实践远非统一。rFVIIa 通常不应用于补偿输血治疗不足。因此，在考虑使用 rFVIIa 治疗 PPH 之前，必须早期有效输注红细胞、新鲜冷冻血浆、纤维蛋白原浓缩物（或冷沉淀）和血小板，并控制子宫收缩乏力。
