Use of rFVIIa for critical bleeding in cardiac surgery: dose variation and patient outcomes

Background and Objectives Recombinant activated factor VIIa (rFVIIa) is increasingly being used in non-haemophiliac patients for the treatment of severe bleeding refractory to standard interventions. Optimal dosing regimens remain debated in cardiac surgery. Therefore, this study investigated the use of different rFVIIa dosing practices on response to bleeding and patient outcomes in cardiac surgery patients using data from the Haemostasis Registry. Methods Data were extracted from the Haemostasis Registry that records cases of off-licence rFVIIa use in participating institutions. Univariate analyses compared patients receiving < 40 mu g/kg, 41-60 mu g/kg, 61-80 mu g/kg, 81-100 mu g/kg and > 100 mu g/kg of rFVIIa on key parameters. Logistic regression models investigated the relationship between independent variables and 28-day mortality. Results Complete data was available on 804 cardiac surgery patients who received rFVIIa. Of these, 42 (5 center dot 2%) were treated with doses < 40 mu g/kg, while the dose group containing the most patients was 81-100 mu g/kg (368, 45 center dot 77%). Results demonstrated no significant differences in the rate of thromboembolic adverse events, response to bleeding or 28-day mortality. Conclusions These findings raise the important question of whether lower doses of rFVIIa may be as effective as higher doses in the treatment of severe bleeding in cardiac surgery patients.