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Activated recombinant factor VII in massive bleeding after cardiac surgery: case series
ORAL ABSTRACT PRESENTATIONS / Journal of Cardiothoracic and Vascular Anesthesia 31 (2017) S34–S69
Discussion: There is a rising trend for interventional closure of ASD in recent years with various devices due to multiple reasons [1-2 ] Nevertheless they are associated with some if not many complications such as device malposition, device migration, cardiac rupture and of course less commonly device endocarditis[ 3 ]. Conclusion: Although the complications for ASD devices are minor, sometimes they can be very disastrous leading to high mortality in a rapid transit of time, making surgical intervention mandatory for emergency surgery with device retrieval and for the correction of original defect and other device related defects. REFERENCES: 1. Masura J, Gavora P, Podnar T. Long-term outcome of transcathetersecundum-type atrial septal defect closure using Amplatzer septal occluders. J Am CollCardiol. 2005;45:505–507. 2. Austin EH. Editorial. Transcathetr closure of atrial septal defects. J ThoracCardiovascSurg 2000;120:1032–1033. 3. Majunke N, Bialkowski J, Wilson N. Closure of atrial septal defect with the Amplatzer septal occluder in adults. Am J Cardiol. 2009;103:550–554.
Poster Session PS06 Thursday, 20 April 2017 14:30 - 16:00, Poster & Exhibition Lounges
PP51 Activated recombinant factor VII in massive bleeding after cardiac surgery: case series
Victoria Baños Lapuente, J Miralles Bagán, T Koller, M Argilaga Nogués, P Paniagua Iglesias, J Galán Serrano Hospital de Sant Pau, Department of Anaesthesiology, Barcelona, Spain Introduction: Uncontrolled massive haemorrhage is an important cause of morbidity and mortality in patients after cardiac surgery [1]. Recombinant factor VIIa (rFVIIa) is a haemostatic agent licensed for patients with haemophilia [2]. Its “off-label” use in the treatment of severe bleeding in other patients is controversial nowadays: there are no studies supporting efficacy and security of this drug.
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replacement and four ascending aorta replacement (one aortic aneurysm and three aortic dissections). Massive bleeding and the resulting coagulation disorders were treated in accordance to our specific institutional protocol. Moreover, in order to comply with this, rFVIIa was administered only if the following conditions were met: normal thromboelastogram, optimised global coagulation tests, patient temperature, ionic calcium level and pH correction, and absence of any indication of surgical revision. Family members of the patients gave their informed consent before rFVIIa was administered. Results: In five out of these eight patients, massive bleeding was controlled immediately after a single dose of 90 mcg/kg of rFVlla. However, three of them required additional doses due to continued bleeding. Out of this group of three patients, two of them suffered heparin-induced thrombocytopenia, requiring anticoagulation with bivalirudin during the cardio-pulmonary by-pass. In addition, one of the latter group required a third dose of rFVIIa. Out of the eight patients, one died 72 hours after the administration of a single rFVlla dose due to a diffuse intestinal ischaemia. One patient died 24 hours after a single dose of rFVlla, due to an ischaemic brain insult. The remaining patients showed no signs of any thromboembolic complications. Two died from septic shock, while four could be discharged from the hospital. No patient died due to bleeding. Repeated doses of rFVIIa were not associated with an increased death risk. Discussion: In our series, rFVIIa was effective in restoring haemostasis. In spite of this, the death of two patients could be related to the potential side effects of the drug. The use of this agent could play a role in the treatment of otherwise untreatable, life-threatening bleeding after cardiac surgery. We consider rFVIIa to be a powerful and promising haemostatic drug which could be contemplated as an option in bleeding patients when the rest of haemostatic agents have been used unsuccessfully. Nevertheless, the possibility of thromboembolic complications makes the “off label” use of rFVIIa controversial.
REFERENCE: 1. Peter Raivio, Raili Suojaranta-Ylinen, Kuitunen A. Recombinant Factor VIIa in the treatment of postoperative haemorrhage after cardiac surgery. Ann Thorac Surg 2005;80:66-71.
PP52 Methods: We present a case series of eight non-haemophilic patients after cardiac surgery who suffered uncontrolled massive haemorrhage, refractory to the administration of usual haemostatic drugs. The cases presented include the following surgical procedures: three cardiac transplants, one combined valve
Tissue rSO2 management during cardiopulmonary bypass and ECMO 1
2
3
2
Anna Semenova , D Bombin , V Agapov , M Kostrykin , 3 M Shigaev
Discussion: There is a rising trend for interventional closure of ASD in recent years with various devices due to multiple reasons [1-2 ] Nevertheless they are associated with some if not many complications such as device malposition, device migration, cardiac rupture and of course less commonly device endocarditis[ 3 ]. Conclusion: Although the complications for ASD devices are minor, sometimes they can be very disastrous leading to high mortality in a rapid transit of time, making surgical intervention mandatory for emergency surgery with device retrieval and for the correction of original defect and other device related defects. REFERENCES: 1. Masura J, Gavora P, Podnar T. Long-term outcome of transcathetersecundum-type atrial septal defect closure using Amplatzer septal occluders. J Am CollCardiol. 2005;45:505–507. 2. Austin EH. Editorial. Transcathetr closure of atrial septal defects. J ThoracCardiovascSurg 2000;120:1032–1033. 3. Majunke N, Bialkowski J, Wilson N. Closure of atrial septal defect with the Amplatzer septal occluder in adults. Am J Cardiol. 2009;103:550–554.
Poster Session PS06 Thursday, 20 April 2017 14:30 - 16:00, Poster & Exhibition Lounges
PP51 Activated recombinant factor VII in massive bleeding after cardiac surgery: case series
Victoria Baños Lapuente, J Miralles Bagán, T Koller, M Argilaga Nogués, P Paniagua Iglesias, J Galán Serrano Hospital de Sant Pau, Department of Anaesthesiology, Barcelona, Spain Introduction: Uncontrolled massive haemorrhage is an important cause of morbidity and mortality in patients after cardiac surgery [1]. Recombinant factor VIIa (rFVIIa) is a haemostatic agent licensed for patients with haemophilia [2]. Its “off-label” use in the treatment of severe bleeding in other patients is controversial nowadays: there are no studies supporting efficacy and security of this drug.
S63
replacement and four ascending aorta replacement (one aortic aneurysm and three aortic dissections). Massive bleeding and the resulting coagulation disorders were treated in accordance to our specific institutional protocol. Moreover, in order to comply with this, rFVIIa was administered only if the following conditions were met: normal thromboelastogram, optimised global coagulation tests, patient temperature, ionic calcium level and pH correction, and absence of any indication of surgical revision. Family members of the patients gave their informed consent before rFVIIa was administered. Results: In five out of these eight patients, massive bleeding was controlled immediately after a single dose of 90 mcg/kg of rFVlla. However, three of them required additional doses due to continued bleeding. Out of this group of three patients, two of them suffered heparin-induced thrombocytopenia, requiring anticoagulation with bivalirudin during the cardio-pulmonary by-pass. In addition, one of the latter group required a third dose of rFVIIa. Out of the eight patients, one died 72 hours after the administration of a single rFVlla dose due to a diffuse intestinal ischaemia. One patient died 24 hours after a single dose of rFVlla, due to an ischaemic brain insult. The remaining patients showed no signs of any thromboembolic complications. Two died from septic shock, while four could be discharged from the hospital. No patient died due to bleeding. Repeated doses of rFVIIa were not associated with an increased death risk. Discussion: In our series, rFVIIa was effective in restoring haemostasis. In spite of this, the death of two patients could be related to the potential side effects of the drug. The use of this agent could play a role in the treatment of otherwise untreatable, life-threatening bleeding after cardiac surgery. We consider rFVIIa to be a powerful and promising haemostatic drug which could be contemplated as an option in bleeding patients when the rest of haemostatic agents have been used unsuccessfully. Nevertheless, the possibility of thromboembolic complications makes the “off label” use of rFVIIa controversial.
REFERENCE: 1. Peter Raivio, Raili Suojaranta-Ylinen, Kuitunen A. Recombinant Factor VIIa in the treatment of postoperative haemorrhage after cardiac surgery. Ann Thorac Surg 2005;80:66-71.
PP52 Methods: We present a case series of eight non-haemophilic patients after cardiac surgery who suffered uncontrolled massive haemorrhage, refractory to the administration of usual haemostatic drugs. The cases presented include the following surgical procedures: three cardiac transplants, one combined valve
Tissue rSO2 management during cardiopulmonary bypass and ECMO 1
2
3
2
Anna Semenova , D Bombin , V Agapov , M Kostrykin , 3 M Shigaev