Recombinant Factor VIIa for The Management of Uncontrollable Bleeding Following The Repair of Acute Type A Aortic Dissection
Background: Bleeding is a serious complication after surgical repair of acute type A aortic dissection. Recombinant factor VIIa (rFVIIa) could be used for the management of severe bleeding; however, it could lead to thromboembolic events. We aimed to report our experience in using rFVIIa in the management of severe bleeding following the surgical repair of acute type A aortic dissection.
Methods: We performed a retrospective study, including patients who had surgery for acute aortic dissection type A and received rFVIIa, in the period between January 2012 and January 2019. We reported the amount of bleeding 4 hours before and after the administration of rFVIIa, the number of blood products transfused before and after the use of rFVIIa, thrombosis of the central venous line, as well as the presence of disseminated intravascular coagulation.
Results: There were ten patients (2 females and 8 males) out of 120 patients with acute type A aortic dissection, who required the use of rFVIIa for severe postoperative bleeding. The mean age was 67.7±10.5 years. The amount of drainage decreased from 889±585.6 ml during the 4 hours prior to the infusion, to 165±73.5 ml during the following 4 hours (p<0.001). The patients received 2752±1362.9 ml, and 618±483.3 ml packed RBCs before and after rFVIIa administration, respectively (p< 0.001). The patients received 1601±693.4 and 246±419.6 ml of fresh frozen plasma before and after the use of rFVIIa, respectively (p< 0.001). The prothrombin time decreased after the infusion of rFVIIa (42.7±32 and 17.1±8 seconds, p= 0.001). There were no clinical signs of thromboembolism after its use. Mortality occurred in five patients (50%).
Conclusion: In the life-threatening situation of uncontrollable bleeding following surgical repair of type A acute aortic dissection, rFVIIa may have benefits to control bleeding. Furthers studies are recommended.