Recombinant activated factor VII for the rapid correction of coagulopathy in nonhemophilic neurosurgical patients

OBJECTIVE: Coagulopathy is a significant contraindication,, for neurosurgery. Unfortunately, many coagulopathic patients require urgent neurosurgical I intervention. Standard use of blood products, including fresh frozen plasma or prothrombin,complexes, to correct the coagulopathy often leads to significant delays in treatment. Recombinant activated factor, VII (rFVIIa) is a medication originally designed to treat bleeding in hemophiliacs but also seems to correct a wide variety of coagulopathies, rapidly and safely in nonhemophilic patients. METHODS: The medical, records of nine,patients with coagulopathy requiring urgent neurosurgical intervention were reviewed retrospectively. Each patient was given a dose ranging from 140 to 910 mug/kg of rFVIIa, before undergoing surgery. Pre-rFVIIa coagulation and post-rFVIIa coagulation parameters were obtained. One correction of the coagulopathy thy was verified, each patient underwent the appropriate neurosurgical procedure. RESULTS: The average age of the patients was 40.9 years; six were women. The causes of the coagulopathy included anticoagulant medication liver dysfunction, and dilutional coagulopathy after traumatic hemorrhage. Neurosurgical indications included intraparenchymal/intraventricular hemorrhage, hydrocephalus, diffuse cerebral edema, and epidural hematoma. Post-rFVII a coagulation parameters, obtained as early as 20 minutes after infusion of the medication showed normalization of values. There, l were no procedural or operative, complications and no postoperative hemorrhagic complications. No associated thromboembollic or,other complications with, the use of. rFVIIa were observed. CONCLUSION: The use of rFVIIa for the urgent surgical treatment of coagulopathic a patients is quite promising. Further studies, including randomized, prospective, trials using rFVIIa to address issues such as optimal dosing, efficacy, surgical indications, cost-effectiveness, morbidity, and mortality are needed.