Recombinant Activated Factor VII in Obstetric Hemorrhage: Experiences from the Australian and New Zealand Haemostasis Registry

• Published in: Anesthesia and analgesia Vol. 109; no. 6; pp. 1908 - 1915
• Main Authors: Phillips, Louise E., McLintock, Claire, Pollock, Wendy, Gatt, Stephen, Popham, Philip, Jankelowitz, Gary, Ogle, Robert, Cameron, Peter A.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01-12-2009; Lippincott Williams & Wilkins
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Australia; Biological and medical sciences; Blood Transfusion; Coagulants - adverse effects; Coagulants - therapeutic use; Factor VIIa - adverse effects; Factor VIIa - therapeutic use; Female; Hemorrhage - blood; Hemorrhage - drug therapy; Hemorrhage - mortality; Hemorrhage - surgery; Hemostasis - drug effects; Humans; Hysterectomy; Medical sciences; New Zealand; Postpartum Hemorrhage - blood; Postpartum Hemorrhage - drug therapy; Postpartum Hemorrhage - mortality; Postpartum Hemorrhage - surgery; Pregnancy; Pregnancy Complications, Hematologic - blood; Pregnancy Complications, Hematologic - drug therapy; Pregnancy Complications, Hematologic - mortality; Pregnancy Complications, Hematologic - surgery; Recombinant Proteins - adverse effects; Recombinant Proteins - therapeutic use; Registries; Time Factors; Treatment Outcome; New Zealand; Oceania; Anesthesia; Hemorrhage; Obstetrics
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/ANE.0b013e3181c039e6

Through the Australian and New Zealand Haemostasis Registry, we report on the Australian and New Zealand experience with recombinant activated factor VII (rFVIIa) in obstetric patients.
The role of rFVIIa for off-label indications, including trauma, cardiac surgery, and severe postpartum hemorrhage, remains controversial. The Haemostasis Registry established by Monash University in Melbourne, Australia monitors off-label use of rFVIIa across Australia and New Zealand. The purpose of this study was to summarize Registry data for all obstetric hemorrhage patients treated with rFVIIa at participating hospitals between January 2002 and July 2008. The primary outcome measures were reduction or cessation of bleeding (positive therapeutic response), mortality, and hysterectomy rate.
During the study period, the Registry received data for 2128 patients. This included 110 cases of administration of rFVIIa in obstetric patients from 38 hospitals, comprising 5% of the total Registry population, 105 of whom were treated for acute hemorrhage. Women received median (interquartile range) individual doses of 92 microg/kg (73-100) of rFVIIa (median total dose 92 microg/kg [58-108]), and 78% of patients received a single dose. The positive response rate to rFVIIa was 76% with 64% responding to the first dose. Ninety-one percent of women were alive at 28 days. Forty-three women (41%) underwent hysterectomy before receiving rFVIIa and, of those remaining, 13 (21%) required hysterectomy after rFVIIa therapy. Two thromboembolic events (1 pulmonary embolism and 1 deep venous thrombosis) and 1 case of hypoxic-ischemic encephalopathy resulting from severe anoxia were reported.
The reported effect of rFVIIa in many, but not all, obstetric cases was positive. There was no mortality as a result of thromboembolic complications. Randomized, controlled trials are required to confirm its safety and efficacy and to assess the possibility that use at an earlier stage in treatment of severe postpartum hemorrhage may avoid the need to resort to postpartum hysterectomy for control of bleeding, thus preserving fertility.