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Hemorrhage from DIC controlled by Factor VIIa
Factor VIIa in Puerperal Hemorrhage With Disseminated Intravascular Coagulation -- Pepas et al. 108 (3): 757 -- Obstetrics & Gynecology
Obstetrics & Gynecology 2006;108:757-761
Factor VIIa in Puerperal Hemorrhage With Disseminated Intravascular Coagulation
Litha P. Pepas, MBBS, BSc, Merhnoosh Arif-Adib and Rezan A. Kadir, MD
From the Department of Obstetrics and Gynecology, Royal Free Hospital, Pont Street, Hampstead, London, United Kingdom.
BACKROUND: Puerperal hemorrhage associated with disseminated intravascular coagulation is a life-threatening obstetric emergency. Recombinant factor VIIa is a novel hemostatic agent, but more information concerning its dosage, efficacy, and safety is required.
CASE: A primigravida developed preeclampsia complicated by disseminated intravascular coagulation and severe puerperal hemorrhage after an emergency cesarean at 35+5 weeks of gestation. Two doses of recombinant factor VIIa controlled the hemorrhage without any thrombotic complications.
CONCLUSION: Recombinant factor VIIa should be considered when conventional methods fail to control puerperal hemorrhage complicated by disseminated intravascular coagulation. A review of 17 similar cases treated with this hemostatic agent revealed that in 76% a single dose ranging from 16.7 to 120 µg/kg controlled bleeding. Guidelines are needed to help obstetricians use recombinant factor VIIa effectively in such emergencies.
Blood Coagul Fibrinolysis. 2005 Jun;16(4):297-9.
Treatment of intra-abdominal bleeding with recombinant activated factor VII in a patient with disseminated intravascular coagulation secondary to septic shock
Martínez J, Cid AR, de la Rubia J, Gimeno R.
Department of Haematology, Hospital Universitario La Fe, Av. Campanar 21, 46009 Valencia, Spain.
Although mainly indicated for treatment of bleeding in haemophilia patients with inhibitors, recombinant activated factor VII (rFVIIa) has also been successfully used in other situations. However, no data are available on its use in the treatment of disseminated intravascular coagulation (DIC) secondary to septic shock. We report a man with DIC and septic shock due to retrocaecal appendicitis and severe intra-abdominal bleeding after surgery. Despite conventional treatment, the bleeding persisted, and treatment with rFVIIa controlled the haemorrhage. No side-effects related to rFVIIa were noted. This case suggests a potential role of rFVIIa in the treatment of severe bleeding associated with DIC.
PMID: 15870551 [PubMed - indexed for MEDLINE]
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