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Vascular Injury and Thrombotic Potential: A Note of Caution About Recombinant Factor VIIa

Departments of Anesthesia and Physiology, mazerd{at}smh.toronto.on.ca, Department of Surgery, University of Toronto

Howard Leong-Poi, MD, FRCPC

Department of Medicine, University of Toronto, Department of Surgery, University of Toronto

James Mahoney, MD, FRCSC

Department of Surgery, University of Toronto

David Latter, MD, FRCSC

Department of Surgery, University of Toronto

Bradley H. Strauss, MD, FRCPC

Department of Medicine, University of Toronto, Sunnybrook Health Sciences Centre, University of toronto, Keenan Research Centre, Li Ka Shing Knowledge Institute, and St Michael's Hospital, University of Toronto, Ontario, Canada

Jerome M. Teitel, MD, FRCPC

Department of Medicine, University of Toronto, Department of Surgery, University of Toronto

Postoperative hemorrhage following cardiac surgery increases morbidity, mortality, and costs. Several case reports have described the successful use of recombinant factor VIIa to decrease or stop bleeding in patients undergoing cardiac surgery. The mechanism of action of recombinant factor VIIa is thought to be increased site-specific thrombin generation by tissue factor—mediated activation of coagulation or from activated platelets. However, there have also been many reports of thrombotic complications after recombinant factor VIIa administration. Randomized clinical trials and further laboratory studies should help better clarify the efficacy, safety, cost-effectiveness, and optimal dosing of recombinant factor VIIa in the cardiac surgical setting.

Key Words: recombinant factor VIIa • surgery • cardiac surgery • thrombosis • complications

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