The use of recombinant factor VIIa in liver diseases.

Recombinant activated factor VII, a bypassing hemostatic agent originally developed for the treatment of hemorrhages in hemophilic patients with inhibitors, is increasingly being employed on a compassionate use basis for the treatment of uncontrolled massive bleeding from various causes. In this review, we present the current knowledge on the use of this agent in patients with severe coagulopathy due to end-stage liver disease. In particular, the role of recombinant activated factor VII for treating gastrointestinal bleeding episodes in patients with decompensated cirrhosis or for prophylaxis before liver surgical or invasive procedures will be addressed. The pathogenesis of complex coagulopathy in chronic liver diseases and the mechanisms by which recombinant activated factor VII might improve coagulation in such patients will also be described. Given the paucity of the published data and the lack of randomized trials, there is not enough evidence to support the extensive use of recombinant activated factor VII in any of the clinical indications analyzed. In conclusion, further large randomized, controlled clinical trials are needed to better define the role of recombinant activated factor VII in the treatment of bleeding complications of liver disorders.