Recombinant Factor VIIa in Pediatric Patients

SUMMARY To date, the majority of experience with recombinant factor VIIa (rFVIIa) has been in patients with hemophilia who developed auto‐antibodies (inhibitors) against factor VIII. This paper examines the reported experiences with rFVIIa use in non‐hemophiliac pediatric‐aged patients and is based on a review of the literature as well as an evaluation of isolated case reports and case series. The literature contains reports on the successful use of rFVIIa in approximately 40 non‐hemophiliac pediatric patients with acquired coagulation dysfunction of various etiologies as well as inherited disorders of platelet function. Although clinical experience is somewhat limited, no significant adverse effects have been noted in the pediatric‐aged patient. Given its potential therapeutic impact, rFVIIa warrants further investigation in the pediatric population. As the reports in the literature illustrate, rFVIIa may be indicated in coagulopathic states to control active bleeding or as prophylaxis to correct coagulation function prior to an invasive procedure. rFVIIa may be considered when the coagulopathy does not respond to FFP, time constraints do not allow for blood typing, thawing and administration of FFP, or there are concerns regarding the potential hemodynamic effects of FFP.