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Recombinant activated factor VII in patients with acute liver failure with UNOS Status 1 A : a single tertiary academic centre experience
Author(s) -
Pham H. P.,
Hsu S. X.,
ParkerJones S.,
Samstein B.,
Diuguid D.,
Schwartz J.
Publication year - 2014
Publication title -
vox sanguinis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.68
H-Index - 83
eISSN - 1423-0410
pISSN - 0042-9007
DOI - 10.1111/vox.12067
Subject(s) - medicine , partial thromboplastin time , prothrombin time , adverse effect , liver transplantation , thrombosis , intensive care unit , surgery , anesthesia , platelet , transplantation
Background and Objectives Recombinant activated factor VII ( rFVII a) is often used in off‐label indications, including many situations in which the patients are at risk of thrombosis. In this study, we retrospectively reviewed the use of rFVII a in patients with acute liver failure – UNOS Status 1 A ( ALF ‐1 A ) to determine its efficacy and safety profile. Materials and Methods Using the transplantation records, all adult patients with ALF ‐1 A were identified from 6/2001 to 3/2009. From patients' medical charts, rFVII a dose, blood component usage, short‐term outcomes [length of intensive care unit ( ICU ) and hospital stay, ability to undergo orthotopic liver transplant ( OLT ) and in‐hospital survival rate] and adverse events were examined. Results Forty‐two patients with ALF ‐1 A were identified. Fifteen patients received rFVII a with doses ranging between 24·4 μg/kg and 126·8 μg/kg. Three patients received two doses of rFVII a. The age, baseline activated partial thromboplastin time ( aPTT ) and platelet ( PLT ) count were not statistically different between the group receiving rFVII a versus the group that did not. However, the prothrombin time ( PT ) was significantly higher in the rFVII a group. Although the rFVII a group stayed in the ICU longer and required significant more blood products during admission, there was no statistical difference between the two groups in terms of length of hospital stay, ability to undergo OLT and survival rate. There was no increase in complications, including thrombosis, after receiving rFVII a. Conclusion Recombinant activated factor VII ( rFVII a) appears to be safe in patients with ALF ‐1 A , but to elucidate its full role, a randomized controlled trial would be ideal.