Formulary Management of Recombinant Factor VIIa at an Academic Medical Center

• Published in: The Annals of pharmacotherapy Vol. 42; no. 6; pp. 771 - 776
• Main Authors: Owen, Phillip S, Golightly, Larry K, MacLaren, Robert, Ferretti, Kenneth A, Badesch, David B
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA Harvey Whitney Books 01-06-2008; SAGE Publications; Whitney
• Subjects: Acute Disease; Biological and medical sciences; Cardiac Surgical Procedures - statistics & numerical data; Coagulants - administration & dosage; Coagulants - adverse effects; Coagulants - economics; Colorado; Dose-Response Relationship, Drug; Drug Costs - statistics & numerical data; Drug Utilization - statistics & numerical data; Evidence-Based Medicine - organization & administration; Factor VIIa - administration & dosage; Factor VIIa - adverse effects; Factor VIIa - economics; Formularies, Hospital; Guideline Adherence - statistics & numerical data; Hematologic and hematopoietic diseases; Hemorrhage - drug therapy; Hemorrhage - etiology; Hospitals, University; Humans; Medical sciences; Pharmacology. Drug treatments; Platelet diseases and coagulopathies; Practice Guidelines as Topic; Recombinant Proteins - administration & dosage; Recombinant Proteins - adverse effects; Recombinant Proteins - economics; Retrospective Studies; Treatment Outcome; formulary management; hemophilia; recombinant human coagulation factor VIIa; Human; Serine endopeptidases; Enzyme; Eptacog alfa (activated); Hemopathy; Genetic disease; Medicine; Peptidases; recombinant human coagumation factor VIIa; Clinical management; Hemophilia; Hydrolases; Recombinant protein; Coagulation factor; Coagulopathy; Coagulation Factor VIIa
• ISSN: 1060-0280; 1542-6270
• DOI: 10.1345/aph.1L047

Background:
Recombinant human coagulation factor VIIa (rVIIa) is a procoagulant indicated for treatment of bleeding in patients with hemophilia. A large proportion of rVIIa utilization is for off-label administration in nonhemophiliac patients with acute hemorrhage. Concerns of potentially inappropriate use, safety, and cost of rVIIa led to efforts to standardize use of this agent.
Objective:
To comparatively describe the utilization of rVIIa upon implementation of an evidence-based guideline at a university hospital.
Methods:
With advisory direction from a multidisciplinary task force, an evidence-based guideline for use of rVIIa was developed, approved, and fully implemented. Assessment of appropriateness of use and retrospective review were required for all cases. Effects of these actions were evaluated by auditing and comparing rVIIa use in patients treated in two 6-month observation periods before and after guideline implementation. Outcomes assessed were proportions of patients deemed appropriate to receive rVIIa, compliance with dosing recommendations, and acquisition costs.
Results:
Twenty-two and 29 patients were treated in the periods before and after guideline implementation, respectively. Patient characteristics were similar, except more cardiothoracic surgeries were performed in patients treated before implementation of the guideline. Indications for rVIIa use were judged appropriate in 21 (95.5%) before-cases and in all (100%) after-cases. The dose was compliant in 1 (4.6%) before-case and 27 (93.1%) after-cases (p conclusions: A guideline based on currently available evidence can serve to sustain the clinical appropriateness of rVIIa therapy and substantially decrease costs.