Acute coagulopathy after reperfusion of the liver graft in children correction with recombinant activated factor VII

• Published in: Transplantation proceedings Vol. 35; no. 6; pp. 2318 - 2319
• Main Authors: Markiewicz, M, Kalicinski, P, Kaminski, A, Laniewski, P, Ismail, H, Drewniak, T, Szymczak, M, Nachulewicz, P
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01-09-2003; Elsevier Science
• Subjects: Biological and medical sciences; Blood Coagulation Disorders - drug therapy; Blood Coagulation Disorders - etiology; Blood. Blood coagulation. Reticuloendothelial system; Child; Factor VIIa - administration & dosage; Factor VIIa - therapeutic use; Fibrinolytic Agents - therapeutic use; Hematologic and hematopoietic diseases; Hemorrhage - drug therapy; Hemorrhage - etiology; Humans; Injections, Intravenous; Liver Transplantation - adverse effects; Medical sciences; Partial Thromboplastin Time; Pharmacology. Drug treatments; Platelet diseases and coagulopathies; Recombinant Proteins - administration & dosage; Recombinant Proteins - therapeutic use; Reperfusion Injury - drug therapy; Human; Serine endopeptidases; Digestive system; Enzyme; Acute; Treatment efficiency; Liver; Hemopathy; Transplantation; Correction factor; Homotransplantation; Factor VII; Peptidases; Reperfusion; Treatment; Surgery; Graft; Hydrolases; Recombinant protein; Child; Coagulation factor; Coagulation Factor VIIa; Coagulopathy
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/S0041-1345(03)00784-X

Several studies have proven that massive blood loss increases postoperative morbidity and mortality in liver graft recipients. Since we have successfully corrected coagulopathy preoperatively using an intravenous (IV) bolus of recombinant activated factor VII (rFVIIa) in 2 patients with fulminant liver failure, we observed that there was rapid reversal of preexisting advanced coagulopathy in another 40 patients with high risk for intraoperative bleeding by this treatment immediately before transplantation. Recently to control hemostasis we have administered rFVIIa also to patients presenting with acute coagulopathy and nonsurgical bleeding after graft reperfusion as described herein.
We have used rFVIIa in 7 children presenting with severe coagulopathy and nonsurgical bleeding after liver graft reperfusion. The dosage of rFVIIa ranged between 37 and 148 mcg/kg. An antifibrinolytic agent (aprotinin, tranexamic acid) was administered simultaneously.
APTT before rFVIIa was 86.10 to 183 seconds, (mean, 132.1 +/− 39.88), after the bolus of rFVIIa 49.4 to 206.1 (mean, 112.7 +/− 58.53), and at the end of surgery 71.70 to 180 (mean, 110.3 +/− 40.98). INR after reperfusion was 1.82 to 3.91 (mean, 2.56 +/− 0.67), 1.03 to 1.92 (mean, 1.54 +/− 0.35) after rFVIIa, and 1.74 to 5.58 (mean, 2.64 +/− 1.35) at the end of surgery. Before rFVIIa administration intraoperative blood transfusions after graft reperfusion were 900 to 4200 mL of red blood cells (RBC) (0.82–5.4 total blood volume) and after reperfusion 0 to 1800 mL of RBC (0–2.5 TBV). No postoperative vascular complications were observed.
A single dose of rFVIIa effectively reverses the severe coagulopathy developing after graft reperfusion, establishing effective hemostasis in liver transplant recipients without an increased risk of thrombotic complications.