Recombinant factor VIIa for intractable blood loss after cardiac surgery: a propensity score-matched case-control analysis

被引:140
作者
Karkouti, K
Beattie, WS
Wijeysundera, DN
Yau, TM
McCluskey, SA
Ghannam, M
Sutton, D
van Rensburg, A
Karski, J
机构
[1] Univ Toronto, Hlth Network, Toronto Gen Hosp, Dept Anesthesia, Toronto, ON M5G 2C4, Canada
[2] Univ Toronto, Hlth Network, Dept Hlth Policy Management & Evaluat, Toronto, ON M5G 2C4, Canada
[3] Univ Toronto, Hlth Network, Div Hematol, Toronto, ON M5G 2C4, Canada
[4] Univ Toronto, Hlth Network, Div Cardiac Surg, Toronto, ON M5G 2C4, Canada
关键词
D O I
10.1111/j.1537-2995.2005.04216.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Cardiac surgery is occasionally complicated by massive blood loss that is refractory to standard hemostatic interventions. Recombinant factor VIIa (rF-Vlla) is being increasingly used as rescue-therapy in such cases, but little information is available on its safety and efficacy for this indication. STUDY DESIGN AND METHODS: The outcomes of the first 51 cardiac surgery patients who received rF-VIIa for intractable blood loss (from November 2002 to February 2004) at a single institution according to a standardized clinical guideline were compared to 51 matched control patients, with the control patients identified from a large database and matched based on the propensity for massive blood loss. RESULTS: Blood loss and blood product usage were significantly decreased after 2.4 to 4.8 mg of rF-Vlla. In those treated after sternal closure (n = 32), there was a significant reduction in blood loss from the hour before to the hour after treatment: 100 (70, 285) mL (median [25th, 75th percentiles]; p < 0.0001). Except for a slower postoperative recovery and higher incidence of acute renal dysfunction, the adverse event rates were similar between the rF-Vlla-treated patients and their matched controls. CONCLUSIONS: These results suggest that rF-Vlla may be an effective rescue therapy for patients with intractable hemorrhage after cardiac surgery. A clinically important risk of stroke or other major thrombotic complications could not be ruled out by our study. Controlled clinical trials with adequate power to detect the impact of rF-VIIa therapy on morbidity and mortality therefore are necessary before one can recommend its routine use in patients undergoing cardiac surgery who have excessive bleeding.
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页码:26 / 34
页数:9
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