OBJECTIVES: Recombinant activated factor VII (rFVIIa) is used in various surgical procedures to reduce the incidence of major blood loss and the need for re-exploration. Few clinical trials have investigated rFVIIa in cardiac surgery. The authors performed a meta-analysis focusing on the rate of stroke and surgical re-exploration. DESIGN: Meta-analysis. SETTING: Hospitals. PARTICIPANTS: A total of 470 patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Four investigators independently searched PubMed and conference proceedings including backward snowballing (ie, scanning of reference of retrieved articles and pertinent reviews) and contacted international experts. A total of 470 patients (254 receiving rFVIIa and 216 controls) from 6 clinical trials (2 randomized, 3 propensity matched, and 1 case matched) were included in the analysis. The use of rFVIIa was associated with an increased rate of stroke (12/254 [4.7%] in the rFVIIa group v 2/216 [0.9%] in the control arm, odds ratio [OR] = 3.69 [1.1-12.38], p = 0.03) with a nonsignificant reduction in rate of surgical re-exploration (13% v 42% [OR = 0.27 (0.04-1.9), p = 0.19]). The authors observed a trend toward an increase of overall perioperative thromboembolic events (19/254 [7.5%] in the rFVIIa group v 10/216 [5.6%] in the control arm [OR = 1.84 (0.82-4.09), p = 0.14]). No difference in the rate of death was observed. CONCLUSIONS: The administration of rFVIIa in cardiac surgery patients could result in a significant increase of stroke with a trend toward a reduction of the need for surgical re-exploration. The authors do not recommend routine use in cardiac surgery patients. rFVIIa may be considered with caution in patients with refractory life-threatening bleeding.
OBJECTIVES: Recombinant activated factor VII (rFVIIa) is used in various surgical procedures to reduce the incidence of major blood loss and the need for re-exploration. Few clinical trials have investigated rFVIIa in cardiac surgery. The authors performed a meta-analysis focusing on the rate of stroke and surgical re-exploration. DESIGN: Meta-analysis. SETTING: Hospitals. PARTICIPANTS: A total of 470 patients. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Four investigators independently searched PubMed and conference proceedings including backward snowballing (ie, scanning of reference of retrieved articles and pertinent reviews) and contacted international experts. A total of 470 patients (254 receiving rFVIIa and 216 controls) from 6 clinical trials (2 randomized, 3 propensity matched, and 1 case matched) were included in the analysis. The use of rFVIIa was associated with an increased rate of stroke (12/254 [4.7%] in the rFVIIa group v 2/216 [0.9%] in the control arm, odds ratio [OR] = 3.69 [1.1-12.38], p = 0.03) with a nonsignificant reduction in rate of surgical re-exploration (13% v 42% [OR = 0.27 (0.04-1.9), p = 0.19]). The authors observed a trend toward an increase of overall perioperative thromboembolic events (19/254 [7.5%] in the rFVIIa group v 10/216 [5.6%] in the control arm [OR = 1.84 (0.82-4.09), p = 0.14]). No difference in the rate of death was observed. CONCLUSIONS: The administration of rFVIIa in cardiac surgery patients could result in a significant increase of stroke with a trend toward a reduction of the need for surgical re-exploration. The authors do not recommend routine use in cardiac surgery patients. rFVIIa may be considered with caution in patients with refractory life-threatening bleeding.
Authors: Reija Mikkola; Jarmo Gunn; Jouni Heikkinen; Jan-Ola Wistbacka; Kari Teittinen; Kari Kuttila; Jarmo Lahtinen; Tatu Juvonen; Juhani Ke Airaksinen; Fausto Biancari Journal: Blood Transfus Date: 2012-02-22 Impact factor: 3.443
Authors: Ryan J Winstead; Komal Pandya; Jeremy Flynn; George A Davis; Adam Sieg; Maya Guglin; Aric Schadler; Rickey A Evans Journal: J Thromb Thrombolysis Date: 2018-04 Impact factor: 2.300
Authors: Nicholas D Andersen; Syamal D Bhattacharya; Judson B Williams; Emil L Fosbol; Evelyn L Lockhart; Mayur B Patel; Jeffrey G Gaca; Ian J Welsby; G Chad Hughes Journal: Ann Thorac Surg Date: 2012-05-01 Impact factor: 4.330
Authors: Mustafa Kurkluoglu; Alyson M Engle; John P Costello; Narutoshi Hibino; David Zurakowski; Richard A Jonas; John T Berger; Dilip S Nath Journal: J Saudi Heart Assoc Date: 2014-05-20
Authors: Amanda Zatta; Zoe Mcquilten; Rangi Kandane-Rathnayake; James Isbister; Scott Dunkley; John Mcneil; Peter Cameron; Louise Phillips Journal: Blood Transfus Date: 2014-06-05 Impact factor: 3.443
Authors: Christian O'Donnell; Alexander J Rodriguez; Jai Madhok; Husham Sharifi; Hanjay Wang; Connor G O'Brien; Jack Boyd; William Hiesinger; Joe Hsu; Charles C Hill Journal: J Cardiothorac Vasc Anesth Date: 2021-04-25 Impact factor: 2.628
Authors: Antonella Crescenti; Giovanni Borghi; Elena Bignami; Gaia Bertarelli; Giovanni Landoni; Giuseppina Maria Casiraghi; Alberto Briganti; Francesco Montorsi; Patrizio Rigatti; Alberto Zangrillo Journal: BMJ Date: 2011-10-19