Effectiveness of the recombinant factor VIIa in patients with the coagulopathy of advanced child's B and C cirrhosis

Patients with advanced liver cirrhosis have a serious disturbance in their hemostasis system that leads to increased morbidity and mortality. The vitamin K-dependent clotting factors, especially factor VII, are markedly reduced in these patients. Present treatment modalities include fresh frozen plasma (FFP), vitamin K, and desmopressin. FFP has to be given in large volume and entails the risk of transmitting infectious agents. The introduction of recombinant activated factor VII (rFVIIa) has offered another treatment option for patients with liver cirrhosis and bleeding. The clinical experience with rFVIIa is reviewed. Management seems to be effective and safe and the concern that rFVIIa might activate the hemostasis system in these patients has not materialized. Administration of rFVIIa not only corrected the abnormal clotting tests in these patients but also allowed several invasive procedures without the complication of bleeding.