Heart Care Info - Heart Disease Prevention & Treatment

Clinical significance of coagulation studies in predicting response to activated recombinant Factor VII in cardiac surgery patients

AI Lee, F Campigotto, JD Rawn... - British Journal of ..., 2012 - Wiley Online Library Approximately 35% of cardiac surgery patients experience severe postoperative bleeding requiring surgical re-exploration (Mannucci & Levi, 2007). Recombinant activated Factor VII (r FVIIa) is increasingly used for uncontrolled haemorrhage in multiple clinical settings, ...

As few studies have examined the clinical association between coagulation studies and r FVI Ia efficacy in cardiac surgery, we conducted a retrospective study of cardiac surgery patients who received r FVI Ia for uncontrolled haemorrhage at our institution, Brigham and Women s Hospital (BWH). Between September 2005 and March 2011, r FVI Ia was administered 65 times to 50 patients in the BWH Cardiac Surgery Intensive Care Unit (CSICU). Only unique bleeding episodes in different patients were analysed. When r FVI Ia was administered multiple times to the same patient, only data pertaining to the first administration was included. Three patients were excluded: one who received prophylactic r FVI Ia prior to line placement without evidence of bleeding, and two for whom r FVI Ia efficacy could not be determined due to conflicting information in the medical record. Variables closest in proximity to the time of r FVI Ia administration were examined; for accuracy, only variables with fewer than 10% missing values were included for analysis. The primary outcome was r FVI Ia mediated haemostasis, determined by clinical descriptions in the medical record. Univariate analyses were performed using Fisher s exact test. Multivariate analyses were performed using stepwise logistic regression. Secondary outcomes were total number of blood product units transfused and chest tube output before and after r FVI Ia. Concordance was analysed using Mc Nemar s test.