Tomita Emi, Takase Hajime, Tajima Keiichi, Suematsu Yoshihiro
1 Department of Anesthesiology, Tsukuba Memorial Hospital, Ibaraki, Japan.
2 Department of Cardiovascular Surgery, Tsukuba Memorial Hospital, Ibaraki, Japan.
Asian Cardiovasc Thorac Ann. 2017 Feb;25(2):99-104. doi: 10.1177/0218492317689901. Epub 2017 Jan 23.
Objectives Recombinant activated factor VII has been used for the treatment of hemophilia, factor VII deficiency, and Glanzmann's thrombasthenia. Off-label uses have recently been increasing, and there are reports that recombinant activated factor VII is effective for the treatment of excessive bleeding during or after cardiovascular surgery. We retrospectively reviewed the effectiveness of recombinant activated factor VII and its influence on the coagulation system as a treatment for uncontrollable bleeding during cardiovascular surgery. Methods Between April 2009 and May 2015, recombinant activated factor VII was used to treat uncontrollable bleeding during cardiovascular surgery in 17 patients at our hospital. The indications for recombinant activated factor VII administration were critical uncontrollable bleeding during surgery and normal platelet and fibrinogen levels. Results Blood loss significantly decreased in every case after recombinant activated factor VII administration ( p < 0.05). No adverse thromboembolic events were encountered. The prothrombin time-international normalized ratio, activated partial thromboplastin time, fibrin degradation product and D-dimer levels decreased significantly after recombinant activated factor VII administration. One day later, all blood coagulation test values were almost within the normal ranges. Conclusions Recombinant activated factor VII has a strong hemostatic action, but it is necessary to exclude surgical bleeding to exhibit the hemostatic effect. Administration that does not comply with the indications for recombinant activated factor VII may lead to serious complications such as thromboembolism. In properly selected patients, recombinant activated factor VII is an effective agent for the treatment of uncontrollable bleeding during cardiovascular surgery.
目的 重组活化凝血因子 VII 已用于治疗血友病、凝血因子 VII 缺乏症和血小板无力症。其非标签用途近来不断增加，且有报道称重组活化凝血因子 VII 对治疗心血管手术期间或术后的出血过多有效。我们回顾性分析了重组活化凝血因子 VII 作为治疗心血管手术中难以控制的出血的有效性及其对凝血系统的影响。方法 2009 年 4 月至 2015 年 5 月期间，我院 17 例患者在心血管手术中使用重组活化凝血因子 VII 治疗难以控制的出血。重组活化凝血因子 VII 的给药指征为手术期间严重难以控制的出血以及血小板和纤维蛋白原水平正常。结果 给予重组活化凝血因子 VII 后，每例患者的失血量均显著减少（p < 0.05）。未发生不良血栓栓塞事件。给予重组活化凝血因子 VII 后，凝血酶原时间 - 国际标准化比值、活化部分凝血活酶时间、纤维蛋白降解产物和 D - 二聚体水平均显著降低。一天后，所有凝血试验值几乎均在正常范围内。结论 重组活化凝血因子 VII 具有强大的止血作用，但必须排除手术出血才能发挥止血效果。不符合重组活化凝血因子 VII 给药指征的用药可能导致血栓栓塞等严重并发症。在适当选择的患者中，重组活化凝血因子 VII 是治疗心血管手术中难以控制的出血的有效药物。
