Emerging Role of Recombinant Factor VIIa in Neuroscience

Recently published data supporting the positive impact of procoagulant therapy with rFVIIa in ICH patients are quite exciting and could spell a tremendous breakthrough in the practice of neuroscience. A cohort study of stroke patients indicates that approximately 13% of ICH patients have the potential to be candidates for rFVIIa therapy if similar exclusion and inclusion criteria are used on the basis of the previously described phase II trial. These exclusion criteria must remain in the forefront of our minds when we are attempting to extrapolate the findings of clinical research to our own "real-world" practice settings. More data will be available upon completion and publication of the FAST trial results. Perhaps more light will be shed on the safety and efficacy with respect to dose, and an optimal dose will be identified for achieving clot formation without unwanted thrombotic complications. To date, the optimal dose is unknown. This information is critical because of safety concerns as well as the potential financial burden that this agent may have on your hospital's drug budget. The agent is priced between $0.80 and $1.00 per microgram. Therefore, the cost for treatment of a patient weighing 100 kg could range between $3200 and $16 000 depending on the dose (40, 80, or 160 mcg/kg). Because of the wide range of potential doses and the broad number of potential areas of use, rFVIIa has become 1 of the top 10 drug expenditures for many institutions. The acquisition price of the drug may be offset by the potentially positive impact on morbidity and mortality in the patients who receive the agent. Again, this points out the importance of appropriate patient selection when considering rFVIIa as an option. The bedside nurse has a critical role in this process. © 2006 Lippincott Williams & Wilkins, Inc.