COAGULANTS

Can local application of Tranexamic acid reduce post- coronary bypass surgery blood loss? A randomized controlled trial. J Cardiothorac Surg. 2009 Jun 18;4(1):25. [Epub ahead of print] Diffuse microvascular bleeding remains a common problem after cardiac procedures. Systemic use of antifibrinolytic reduces the postoperative blood loss. The purpose of this study was to examine the effectiveness of local application of tranexamic acid to reduce blood loss after coronary artery bypass grafting (CABG). Topical application of tranexamic acid in patients undergoing primary coronary artery bypass grafting led to a significant reduction in postoperative blood loss without adding extra risk to the patient.

Use of Recombinant Factor VIIa to Correct the Coagulation Status of Individuals with Advanced Liver Disease Prior to a Percutaneous Liver Biopsy.Dig Dis Sci. 2009 Mar 14. [Epub ahead of print] Recombinant factor VIIa had a marked effect in transiently correcting the mean prothrombin time in these subjects allowing for a safe complication free percutaneous biopsy in this high-risk group. Recombinant factor VIIa could be used to obtain a clinically indicated liver biopsy in severely ill patients, who without this therapeutic agent, would either not be biopsied or, if biopsied, would require much longer hospitalization and the use of fresh-frozen plasma (with its risks of volume overload and infection).

The use of recombinant activated factor VII in platelet disorders: a critical review of the literature. Blood Transfus. 2009 Jan;7(1):24-8. No abstract available.

The effect of aprotinin, tranexamic acid, and aminocaproic acid on blood loss and use of blood products in major pediatric surgery: A meta-analysis. Pediatr Crit Care Med. 2009 Jan 30. [Epub ahead of print] There is no evidence that suggests that, compared with aprotinin, alternative antifibrinolytics such as tranexamic acid were less effective in reducing blood loss in major pediatric surgery.

Prothrombin complex concentrate vs fresh frozen plasma for reversal of dilutional coagulopathy in a porcine trauma model. Br J Anaesth. 2009 Jan 24. [Epub ahead of print] Fluid resuscitation following traumatic injury causes haemodilution and can contribute to coagulopathy. Coagulation factor replacement may be necessary to prevent bleeding complications of dilutional coagulopathy. Compared with fresh frozen plasma (FFP), prothrombin complex concentrate (PCC) may potentially offer a more rapid and effective means of normalizing coagulation factor levels. PCC was effective in correcting dilutional coagulopathy and controlling bleeding in an in vivo large-animal trauma model. In light of its suitability for more rapid administration than FFP, PCC merits further investigation as a therapy for dilutional coagulopathy in trauma and surgery

Reversal of coagulopathy in critically ill patients with traumatic brain injury: recombinant factor VIIa is more cost-effective than plasma. J Trauma. 2009 Jan;66(1):63-72; discussion 73-5. In this study, we were able to demonstrate a significant economic benefit of the use of rFVIIa for reversal of coagulopathy in severely injured patients with TBI. Not all patients with coagulopathy and an anatomic brain injury benefit, but in patients who are neurologically or physiologically compromised, using rFVIIa decreases total charges and costs of hospitalization. This decrease in overall cost is directly attributable to the significant decrease in LOS and decrease in the need for mechanical ventilation. This study demonstrates that in coagulopathic patients with TBI who require intensive care unit admission, rFVIIa is cost-effective and safe. Prospective studies are needed to confirm these findings and establish clinical effectiveness.

Efficacy of recombinant activated Factor VII in patients with massive uncontrolled bleeding: a retrospective observational analysis. Transfusion. 2008 Nov 25. [Epub ahead of print] This study suggests that rFVIIa may play a role in patients with massive uncontrolled blood loss by reducing the amount of RBC and FFP transfusions and by improving the coagulation variables.

Recombinant activated factor VII use in critically ill infants with active hemorrhage. J Pediatr Surg. 2008 Dec;43(12):2235-8.This is the first large case series demonstrating the efficacy of rFVIIa in critically ill infants with active hemorrhage by reducing their transfusion requirements. Furthermore, venous thrombosis was not associated with increase in either the number of doses or dosage of rFVIIa.

The blood sparing effect and the safety of aprotinin compared to tranexamic acid in paediatric cardiac surgery. Eur J Cardiothorac Surg. 2008 Nov 20. [Epub ahead of print]. Aprotinin administration bears no additional risks compared to tranexamic acid and it has a stronger blood sparing effect in paediatric cardiac surgery. There were fewer rethoracotomies and less postoperative red blood cell transfusion in patients who received aprotinin.

Emergency reversal of antithrombotic treatment.

Intern Emerg Med. 2008 Nov 12. [Epub ahead of print] Heparin and heparin derivatives can be counteracted by protamine sulphate, whereas the anticoagulant effect of vitamin K antagonists may be neutralized by administration of vitamin K or prothrombin complex concentrates. The anti-hemostatic effect of aspirin and other anti-platelet strategies can be corrected by the administration of platelet concentrate or desmopressin, if needed.

Use of antifibrinolytic therapy to reduce transfusion in patients undergoing orthopedic surgery: A systematic review of randomized trials.

Thromb Res. 2008 Nov 11. [Epub ahead of print] Antifibrinolytic agents may reduce bleeding and transfusion in patients undergoing THR or TKA who receive appropriate antithrombotic prophylaxis. There is a need for a large, adequately powered prospective study to carefully examine the safety and efficacy of these agents.

Role of Amicar in Surgery for Neuromuscular Scoliosis.

Spine. 2008 Nov 3 . 2008 Nov 3. 2008 Nov 3. [Epub ahead of print] Amicar was highly effective in decreasing perioperative blood loss and transfusion requirements in patients with neuromuscular scoliosis undergoing PSF and SSI. It was most effective in decreasing estimated intraoperative blood loss. This results in decreased transfusion requirements, costs, and potential transfusion-related complications.

Aprotinin for patients exposed to clopidogrel before off-pump coronary bypass.

Asian Cardiovasc Thorac Ann. 2008 Dec;16(6):483-7. In patients with unstable angina and recent clopidogrel exposure who are undergoing off-pump coronary artery bypass, intraoperative administration of low-dose aprotinin is recommended to reduce blood loss and transfusion requirements.

Prohemostatic agents to prevent perioperative blood loss.

Semin Thromb Hemost. 2008 Jul;34(5):439-44. Epub 2008 Oct 27. Review

Recombinant Factor VIIa Treatment of Severe Bleeding in Cardiac Surgery Patients: A Retrospective Analysis of Dosing, Efficacy, and Safety Outcomes.

J Cardiothorac Vasc Anesth. 2008 Oct 21. [Epub ahead of print] rFVIIa effectively reduces blood product use in cardiovascular surgery patients having massive blood loss. Although the optimal dose of rFVIIa for use in cardiovascular surgery remains undetermined, these data provide evidence that dosing regimens using <90 mug/kg are effective in this population and may provide guidance for centers establishing standardized protocols for rFVIIa use in cardiovascular surgery patients.

Tranexamic Acid reduces perioperative blood loss in adult patients having spinal fusion surgery.

Anesth Analg. 2008 Nov;107(5):1479-86. TXA significantly reduced the estimated and calculated total amount of perioperative blood loss in adult patients having elective posterior thoracic/lumbar instrumented spinal fusion surgery.

Tranexamic acid and aprotinin in primary cardiac operations: an analysis of 220 cardiac surgical patients treated with tranexamic acid or aprotinin.

Anesth Analg. 2008 Nov;107(5):1469-78. Considering the rate of transfusion of red blood cells, tranexamic acid was slightly inferior in patients undergoing CABG, but there was no difference in patients receiving aortic valve replacement. Tranexamic acid seems to be less effective in operations with increased bleeding such as CABG. Clinical benefit depends on specific patient and institution characteristics.

Monitoring recombinant factor VIIa treatment: efficacy depends on high levels of fibrinogen in a model of severe dilutional coagulopathy.

J Cardiothorac Vasc Anesth. 2008 Oct;22(5):675-80. Epub 2008 Apr 9. ROTEM and Sonoclot were able to monitor the effects of rFVIIa and fibrinogen administration with 1:1,000 diluted tissue factor-activated tests. The efficacy of rFVIIa was largely dependent on the presence of high levels of fibrinogen in reversing this severe dilutional coagulopathy.

Factor VIIa and its potential therapeutic use in bleeding-associated pathologies.

Thromb Haemost. 2008 Oct;100(4):557-62. Review

Management of Life-Threatening Hemorrhages and Unsafe Interventions in Nonhemophiliac Children by Recombinant Factor VIIa.

Clin Appl Thromb Hemost. 2008 Oct 6.. 2008 Oct 6.. 2008 Oct 6. [Epub ahead of print] The patient group was composed of 20 patients with different disorders resulting in similar results as hemorrhage or hemorrhage risk. Most of the patients were diagnosed with liver disorders primary or secondary to other diseases. The remaining cases were patients with leukemia, sepsis, intracranial hemorrhage, and burn. Some of the patients had multiple problems like a patient with liver disorder and intracranial hemorrhage or a leukemia patient with sepsis and disseminated intravascular coagulation. This study shows that rFVIIa can be safely used in high-risk patients with a history of recurrent hemorrhage, for whom no improvement can be achieved in the hemostasis tests.

A promising new alternative for the rapid reversal of warfarin coagulopathy in traumatic intracranial hemorrhage.

Am J Surg. 2008 Aug 21. [Epub ahead of print] FIX complex results in an immediate reversal of coagulopathy within 15 minutes after administration. Its use should be considered as an alternative treatment to fresh-frozen plasma and recombinant Factor VIIa. Prospective randomized trials are needed to confirm these findings.

Local and systemic hemostatics in trauma: a review.

Ulus Travma Acil Cerrahi Derg. 2008 Jul;14(3):175-81.This article reviews the role of commercially available local and systemic hemostatic products in the trauma patient population; it also addresses the unique set of characteristics, indications, limitations and rationale for their use.

Diagnosis and treatment of peripartum bleeding.

J Perinat Med. 2008 Sep 10. [Epub ahead of print] An up-to-date presentation of the importance of embolization and of the diagnosis of coagulopathy in PPH is provided. Furthermore, the committee recommends changes in the management of PPH including new surgical options and the off-label use of recombinant factor VIIa.

Modeling the action of factor VIIa in dilutional coagulopathy.

Thromb Res. 2008;122 Suppl 1:S7-S10. Preliminary data suggest that factor VIIa activation of factors X and IX on activated platelets enhances thrombin generation significantly in a model of dilutional coagulopathy. This may suggest a mechanism to account for the efficacy of factor VIIa in reducing blood loss in some settings of dilutional coagulopathy.

Aprotinin in primary cardiac surgery: operative outcome of propensity score-matched study.

Ann Thorac Surg. 2008 Oct;86(4):1195-202.Full-dose aprotinin use was not associated with myocardial infarction, neurologic dysfunction, renal insufficiency, or death after coronary or valve operations. We observed less postoperative bleeding and blood product transfusion, and early extubation with the use of aprotinin.

Elective fresh frozen plasma in the critically ill: what is the evidence?

Crit Care Resusc. 2008 Sep;10(3):264-8. New trials are needed to evaluate the efficacy and adverse effects of plasma, both in bleeding and non-bleeding patients, and to determine whether presumed benefits outweigh the real risks. In addition, new haemostatic tests that better define the risk of bleeding and monitor the effectiveness of FFP use should be validated.

Experiences with recombinant FVIIa in the emergency treatment of patients with autoimmune thrombocytopenia: a review of the literature.

Ann Hematol. 2008 Sep 12. [Epub ahead of print] Case report and review

Prothrombin complex concentrate (Beriplex P/N) in severe bleeding: experience in a large tertiary hospital.

Crit Care. 2008 Aug 15;12(4):R105. [Epub ahead of print] This study emphasises the value of PCC in reversing oral anticoagulant therapy (OAT) in bleeding patients. It has also demonstrated the potential value of PCC for controlling bleeding in The use of PCC in bleeding patients without hereditary or patients undergoing cardiac and other surgical procedures. anticoagulation-related coagulopathy is novel, and further investigation is warranted. In the future, it may be possible to use PCC as a substitute for fresh frozen plasma (FFP) in this setting; adequate documentation is crucial for all blood products.

An evaluation of eptacog alfa in nonhaemophiliac conditions.

Drugs. 2008;68(12):1665-89. Review

Recombinant Activated Factor VII in Critical Bleeding After Orthotopic Liver Transplantation.

Transplant Proc. 2008 Jul-Aug;40(6):1989-90.Awaiting stronger evidence from randomized controlled trials, Authors suggest that in some challenging cases of massive bleeding rFVIIa should be considered a useful option to control bleeding.

Aprotinin's effect on blood product transfusion in off-pump bilateral lung transplantation.

Interact Cardiovasc Thorac Surg. 2008 Jul 31. [Epub ahead of print] The use of aprotinin was associated with a significant reduction in peri-operative total blood products transfused in COPD patients (p=0.03) undergoing OP-BOLT. Subgroup analysis demonstrated that the use of aprotinin in the COPD population did result in a statistically significant decrease in total blood products transfused, specifically the total number of units of packed red blood cells given. These findings suggest that aprotinin administration should be considered for all patients undergoing OP-BOLT to reduce exposure to blood products and potential immune sensitization and infectious complications

Polyphosphate as a general procoagulant agent.

J Thromb Haemost. 2008 Jul 26.. 2008 Jul 26.. 2008 Jul 26. [Epub ahead of print] Polyphosphate significantly shortened the clotting time of plasmas from hemophilia A and B patients and that its procoagulant effect was additive to that of recombinant factor VIIa. Polyphosphate also significantly shortened the clotting time of normal plasmas containing a variety of anticoagulant drugs, including unfractionated heparin, enoxaparin (a low MW heparin), argatroban (a direct thrombin inhibitor) and rivaroxaban (a direct factor Xa inhibitor). Thromboelastography revealed that polyphosphate normalized the clotting dynamics of whole blood containing these anticoagulants, as indicated by changes in clot time, clot formation time, alpha angle and maximum clot firmness.

Low-dose recombinant factor VIIa for trauma patients with coagulopathy.

Injury. 2008 Jul 24.. 2008 Jul 24.. 2008 Jul 24. [Epub ahead of print]Low dose FVIIa rapidly and effectively treats mild to moderate coagulopathy following injury. This low dose (1.2mg) FVIIa is the smallest available unit dose. It costs approximately the same as 8 units of plasma and may be cost-effective in patients who require high volume factor administration. Low dose FVIIa may be effective in coagulopathic trauma patients who are not in shock but require rapid normalisation of clotting function.

Antifibrinolytic agents for reducing blood loss in scoliosis surgery in children.

Cochrane Database Syst Rev. 2008 Jul 16;(3):CD006883.The effect of antifibrinolytic drugs on mortality could not be assessed. Antifibrinolytic drugs reduced blood loss and the amount of blood transfused in children undergoing scoliosis surgery; however, their effect on the number of children requiring blood transfusion remains unclear. Aprotinin, tranexamic acid and aminocaproic acid seem to be similarly effective.

Efficacy of aprotinin as a blood conservation technique for adult deformity spinal surgery: a retrospective study.

Spine. 2008 Jul 15;33(16):1775-81. The administration of aprotinin is a safe and effective method to reduce blood loss and to decrease the need for transfusions without increasing risk of complication in the younger patients in relatively good general health undergoing spinal deformity surgery requiring 6 or more levels of fusion.

Use of recombinant activated factor VII in patients without hemophilia: a meta-analysis of randomized control trials.

Ann Surg. 2008 Jul;248(1):61-8.Use of rFVIIa reduces the need for blood transfusion and it may reduce mortality, especially if the dose of rFVIIa is limited to therapeutic doses of 90 mug/kg. It does not increase the risk of venous thrombosis but it may increase the risk of arterial thrombosis.

Fibrinogen concentrate for acquired hypofibrinogenaemic states.

Transfus Med. 2008 Jun;18(3):151-157 . 2008 Jun;18(3):151-157. Cryoprecipitate is standard treatment for replacement of fibrinogen in acquired hypofibrinogenaemia. A virally inactivated fibrinogen concentrate (Haemocomplettan((R)); CSL Behring, Marburg, Germany) is licensed in some European countries. Purified, virally inactivated fibrinogen concentrate appears effective in the management of acquired hypofibrinogenaemic states and enables rapid administration of a known fibrinogen dose in an emergency setting.

Effect of haemodilution, acidosis, and hypothermia on the activity of recombinant factor VIIa (NovoSeven(R)).

Br J Anaesth. 2008 Jun 18. [Epub ahead of print] Haemodilution progressively altered thromboelastography (TEG) parameters. rFVIIa improved TEG parameters in the presence of acidosis, hypothermia or 20% haemodilution (P<0.05). At 40% haemodilution, the rFVIIa effect was diminished particularly with high molecular weight (MW) hydroxyethyl starch (HES). In vivo, rFVIIa shortened the bleeding time (P<0.05) with low but not high MW HES. Efficacy of rFVIIa was affected by the degree of haemodilution and type of volume expander, but not by acidosis or hypothermia.

Novel antithrombotic agents and the risk of bleeding.

Transfusion. 2008 Mar;48(1 Suppl):47S-50S. Many coronary patients on antiplatelet (PLT) drugs require coronary artery bypass grafting surgery under conditions that may not allow sufficient time for or warrant discontinuation of anti-PLT treatment. Recent clinical data show that intraoperative aprotinin significantly reduces postoperative bleeding and transfusion requirements in this patient population. If surgical bleeding persists, the administration of Factor VIIa should be considered.

The impact of aprotinin on blood loss and blood transfusion in off-pump coronary artery bypass grafting.

Ann Thorac Surg. 2008 May;85(5):1662-8. A total of 761 consecutive adult patients who underwent off-pump coronary artery bypass grafting were retrospectively reviewed. Aprotinin was associated with a significant reduction in postoperative blood loss (p < 0.001) and less excessive postoperative hemorrhage (p < 0.001) compared with the control group. Transfusion rates and amount of blood products administered were also reduced by aprotinin (p < 0.01 for both). Significantly more patients in the aprotinin group were free of any blood product transfusion (54.7%) compared with the control group (41.4%; p < 0.01). The safety profile was comparable between aprotinin and control patients.

Use of recombinant activated factor VII concentrate to control postoperative hemorrhage in complex cardiovascular surgery.

Ann Thorac Surg. 2008 May;85(5):1669-76; discussion 1676-7. A retrospective review evaluating 846 complex cardiovascular surgery patients of whom 36 received rFVIIa. A total of 36 patients received 41 rFVIIa doses with an in-hospital survival of 91.7%. Hemorrhage was controlled in 83.3% of patients, with 1 dose sufficient in 75.0%. There was a significant decrease (p < 0.005) in all blood product requirements post-rFVIIa compared with pre-rFVIIa administration.

Influence of ultra-low dose Aprotinin on thoracic surgical operations: a prospective randomized trial.

J Cardiothorac Surg. 2008 Mar 24;3(1):14 [Epub ahead of print] The perioperative ultra-low dose aprotinin administration was associated with a reduction of total blood losses and blood product requirements. We therefore consider the use of aprotinin safe and effective in major thoracic surgery.

Effectiveness and safety of tranexamic acid administration during total knee arthroplasty.

Vox Sang. 2008 Mar 18; [Epub ahead of print] TA administration reduced the expenditure for RBC transfusion plus the cost of TA from euro148.94 to 33.87 per patient. Routine administration of TA during total knee arthroplasty to patients without history of thromboembolic disease is associated with a 67% reduction in RBC transfusions and, in those transfused, with a reduction in the number of units administered. TA treatment was not associated with an increase in thromboembolic complications. Transfusion costs are significantly reduced.

Improved clot formation by combined administration of activated factor VII (NovoSeven) and fibrinogen (Haemocomplettan P).

Anesth Analg. 2008 Mar;106(3):732-8, The onset of fibrin formation and thrombin generation were shortened after rFVIIa addition, but fibrin clot strength was only increased after fibrinogen supplementation. In vitro clot formation was most improved by using both rFVIIa and fibrinogen in whole blood after CPB.

Recombinant factor VIIa for the treatment of bleeding in major abdominal surgery including vascular and urological surgery - a review and meta-analysis of published data.

Crit Care. 2008 Feb 15;12(1):R14 [Epub ahead of print] The meta-analysis of case series showed that in a mean of 73% patients rFVIIa achieved at least a reduction of bleeding and that the probability of survival is increased in patients responding to rFVIIa. rFVIIa was not associated with an increased risk of thromboembolism compared to placebo.

Guidelines for the use of recombinant activated factor VII in massive obstetric haemorrhage.

Aust N Z J Obstet Gynaecol. 2008 Feb;48(1):12-6. A multidisciplinary group of Australian and New Zealand clinicians from the fields of obstetrics, anaesthesia and haematology, who have both clinical experience in and/or knowledge of rFVIIa was convened by the manufacturer. This group produced an opinion and guideline based on their experience and the published international literature on the use of rFVIIa. This is intended to be used as a guideline and algorithm for the use of rFVIIa, though any use should be tailored to local practice and resources.

Coagulopathy in liver disease.

Curr Treat Options Gastroenterol. 2007 Dec;10(6):464-73. Review

Recombinant factor VIIa as an adjunct in nonoperative management of solid organ injuries in children.

J Pediatr Surg. 2008 Jan;43(1):195-199. Recombinant factor VIIa is a useful adjunctive therapy in pediatric patients with evidence of ongoing hemorrhage from blunt abdominal injury and may reduce the need for invasive therapeutic procedures and transfusions.

Successful combined use of tranexamic Acid and unfractionated heparin for life-threatening bleeding associated with intravascular coagulation in a patient with chronic myelogenous leukemia in blast crisis.

Int J Hematol. 2007 Dec;86(5):403-6. This case report is the first to describe successful treatment with TA combined with heparin for life-threatening intestinal bleeding due to acute DIC associated with hematologic malignancy.

Tranexamic acid reduces blood transfusion in total knee arthroplasty even when a blood conservation program is applied.

Transfusion. 2007 Dec 7; [Epub ahead of print] Tranexamic acid reduces blood losses and transfusion requirements even when a blood conservation program was used and it questions the usefulness of the postoperative reinfusion drains

Use of Recombinant Activated Factor VII in Primary Postpartum Hemorrhage: The Northern European Registry 2000 2004.

Obstet Gynecol. 2007 Dec;110(6):1270-8. Clinical reports and hematologic data suggest improvement for more than 80% of women after rFVIIa administration and few adverse effects.

Treatment of refractory bleeding after cardiac operations with low-dose recombinant activated factor VII (NovoSeven((R))): a propensity score analysis.

Recombinant factor VIIa in patients with platelet function disorders or thrombocytopenia.
Hamostaseologie. 2007;27(4):251-262. Case reports and short treatment series document the efficacy and safety of rFVIIa to achieve haemostasis in patients with platelet function disorders and thrombocytopenias of various origin...In approximately half of the patients with thrombocytopenias, a single bolus of rFVIIa has been shown to be sufficient in managing otherwise untreatable bleeding complications. In these patients, haemostasis was achieved even at platelet counts <20 000/microl, although the efficacy of rFVIIa increases at higher platelet concentrations.

Use of recombinant activated factor VII in massive postpartum haemorrhage.
Eur J Obstet Gynecol Reprod Biol. 2007 Oct 8; [Epub ahead of print] The main cause of postpartum haemorrhage PPH was uterine atony (82%). In 21 cases rFVIIa was explicitly given to prevent a hysterectomy. This was successful in 16 cases (76%). Relevant reduction or complete cessation of bleeding after rFVIIa was noted in 24/27 cases (89%). There was a reduction in blood product requirements following rFVIIa administration. The dose of rFVIIa was variable and ranged from 16 to 128mug/kg. There appears to be a role for the use of rFVIIa in PPH unresponsive to conventional therapy. Recombinant FVIIa can be helpful and avoid an emergency hysterectomy.

Recombinant Factor VIIa: A Useful Tool for Life-Threatening Colonic Bleeding. Report of a Case.
Dis Colon Rectum. 2007 Oct 5; [Epub ahead of print] No abstract available.

Recombinant activated factor VII in spinal surgery: a multicenter, randomized, double-blind, placebo-controlled, dose-escalation trial.
Spine. 2007 Oct 1;32(21):2285-93. No safety concerns were indicated for the use of rFVIIa in patients at all doses tested; rFVIIa reduced adjusted blood loss and adjusted transfusions during spinal surgery.

Potential role of recombinant activated factor VII for the treatment of severe bleeding associated with disseminated intravascular coagulation: a systematic review.
Blood Coagul Fibrinolysis. 2007 Oct;18(7):589-93. Although limited, the data available suggest that rFVIIa could have a potential role in this clinical setting. Large randomized trials are needed, however, to confirm the preliminary results and to assess the safety and dosing regimens of this agent in refractory bleeding associated with disseminated intravascular coagulation.

Tranexamic acid diminishes intraoperative blood loss and transfusion in spinal fusions for duchenne muscular dystrophy scoliosis.
Spine. 2007 Sep 15;32(20):2278-83. Tranexamic acid significantly reduces both intraoperative blood loss and the need for homologous transfusion of whole blood and packed red blood cells in DMD patients undergoing posterior spinal fusion for scoliosis.

Aprotinin may decrease blood loss in complex adult spinal deformity surgery, but it may also increase the risk of acute renal failure.
Spine. 2007 Sep 15;32(20):2265-71. In long spinal arthrodesis for complex adult spinal deformity surgery, aprotinin does reduce intraoperative blood loss, but may increase the risk of acute renal failure, especially in women over the age of 60.

Use of recombinant activated factor VII for massive postpartum hemorrhage.
Acta Obstet Gynecol Scand. 2007 Aug 29;:1-7 [Epub ahead of print] Activated recombinant factor VII can be a life-saving drug in patients with massive postpartum hemorrhage.

Dosing factor VIIa (recombinant) in nonhemophiliac patients with bleeding after cardiac surgery.
Am J Health Syst Pharm. 2007 Sep 1;64(17):1808-12. No particular dose of factor VIIa (recombinant) is strongly supported in the literature for off-label use, and thromboembolic events may be dose dependent. Use of the smallest possible dose is warranted because of the high cost of factor VIIa (recombinant) and the potential for thromboembolic events. A single dose of 2.4 or 4.8 mg or 45 microg/kg should be considered.

Recombinant activated factor VII for a warfarinised Jehovah's Witness with an acute subdural haematoma.
J Clin Neurosci. 2007 Aug 14; [Epub ahead of print] Case report.

Randomized Study of Aprotinin Effect on Transfusions and Blood Loss in Primary THA.
Clin Orthop Relat Res. 2007 Aug 30; [Epub ahead of print] Aprotinin reduced transfusions by 46% (30 of 176 versus 56 of 177 patients). Aprotinin reduced the total number of any blood units and the number of allogeneic blood units transfused relative to placebo (48 versus 109 units and 30 versus 72 units, respectively). Serious complications were similar in the two groups (placebo, 11%; aprotinin, 10%). Our data suggest full-dose aprotinin is safe and effective in decreasing blood transfusion in total hip arthroplasty.

Dosing factor VIIa (recombinant) in nonhemophiliac patients with bleeding after cardiac surgery.
Am J Health Syst Pharm. 2007 Sep 1;64(17):1808-12.No particular dose of factor VIIa (recombinant) is strongly supported in the literature for off-label use, and thromboembolic events may be dose dependent. Use of the smallest possible dose is warranted because of the high cost of factor VIIa (recombinant) and the potential for thromboembolic events. A single dose of 2.4 or 4.8 mg or 45 microg/kg should be considered.

Is recombinant activated factor VII useful for intractable bleeding after cardiac surgery?
Interact Cardiovasc Thorac Surg. 2006 Aug;5(4):493-8. Epub 2006 May 3. For patients with intractable bleeding post cardiac surgery refractory to conventional haemostatic interventions, Factor VIIa is recommended and its complication rates are low.

Aprotinin and nafamostat mesilate in liver surgery: effect on blood loss.
Dig Surg. 2007;24(4):282-7. Epub 2007 Jul 27. There is currently no scientific support for the routine use of aprotinin or nafamostat mesilate in patients undergoing partial hepatectomy, whereas the efficacy of aprotinin in liver transplantation is well established

Hemostatic alterations in liver disease: a review on pathophysiology, clinical consequences, and treatment.
Dig Surg. 2007;24(4):250-8. Epub 2007 Jul 27. Review

Administration of Recombinant Activated Factor VII (NovoSeven) in Three Cases of Uncontrolled Bleeding Caused by Disseminated Intravascular Coagulopathy.
Clin Appl Thromb Hemost. 2007 Jul;13(3):313-7. This article presents 3 patients with severe sepsis and fulminant disseminated intravascular coagulation. Excessive microvascular bleeding persisted despite conventional therapy, and surgical intervention and radiologic embolization did not control bleeding. After administration of recombinant activated factor VII, bleeding ceased in all patients, and no overt thromboembolic events occurred.

The role of recombinant factor VIIa in on-pump cardiac surgery: Proceedings of the Canadian Consensus Conference.
Can J Anaesth. 2007 Jul;54(7):573-82. In cardiac surgery, the risks and benefits of rFVIIa are unclear, but current evidence suggests that its benefits may outweigh its risks for rescue therapy in selected patients.

Successful treatment of severe gastrointestinal bleeding secondary to Crohn disease with recombinant factor VIIa.
South Med J. 2007 Jun;100(6):601-4. Acute gastrointestinal bleeding is an unusual complication in Crohn disease. In this case, the use of recombinant activated factor VIIa controlled the massive gastrointestinal bleeding secondary to Crohn disease and without clinically significant adverse effect.

Recombinant factor seven therapy for postoperative bleeding in neonatal and pediatric cardiac surgery.
Ann Thorac Surg. 2007 Jul;84(1):161-8. The rFVIIa therapy seems to be an effective treatment for severe bleeding in postoperative pediatric cardiac surgery patients in the absence of surgical bleeding.

Clinical experience with recombinant activated factor VII in a series of 45 trauma patients.
J R Army Med Corps. 2007 Mar;153(1):32-9. Haemostatic efficacy was achieved in 43/45 (95.6%) patients following rFVIIa administration, and transfusion requirements (defined as median units of packed red blood cells administered in the 24-hour period following rFVIIa administration) were reduced from 10 to 3 units (P < 0.001).

Efficacy and safety of aprotinin use for reoperative valvular surgery.
Ann Thorac Surg. 2007 Jun;83(6):2060-5. The mortality and morbidity in redo valve surgery with aprotinin administration was comparable with primary valve surgery without aprotinin. Bleeding and transfusion requirements were significantly lower in redo patients receiving aprotinin.

Evaluating the safety implications of aprotinin use: the Retrospective Evaluation of Aprotinin in Cardio Thoracic Surgery (REACTS).
J Thorac Cardiovasc Surg. 2007 Jun;133(6):1547-52. Aprotinin was not associated with negative myocardial or cerebrovascular risks but did increase the risk of renal dysfunction. It is not known whether the renal dysfunction reflects renal damage or a transient reduction in glomerular filtration pressure.

Meta-Analysis Comparing the Effectiveness and Adverse Outcomes of Antifibrinolytic Agents in Cardiac Surgery.
Circulation. 2007 May 28; [Epub ahead of print] All antifibrinolytic agents were effective in reducing blood loss and transfusion. There were no significant risks or benefits for mortality, stroke, myocardial infarction, or renal failure. However, high-dose aprotinin was associated with a statistically significant increased risk of renal dysfunction

Impact of aspirin with or without clopidogrel on postoperative bleeding and blood transfusion in coronary surgical patients treated prophylactically with a low-dose of aprotinin.
Eur Heart J. 2007 Apr 12; [Epub ahead of print] In patients undergoing first-time CABG and treated prophylactically with aprotinin, aspirin and clopidogrel may be continued until surgery without increasing postoperative bleeding or transfusion requirements.

Coagulopathy: Its Pathophysiology and Treatment in the Injured Patient.
World J Surg. 2007 Mar 30; [Epub ahead of print] Review

Cost reduction of perioperative coagulation management in cardiac surgery: value of 'bedside' thrombelastography (ROTEM).
Eur J Cardiothorac Surg. 2007 Mar 28; [Epub ahead of print] Cumulative costs for treatment of perioperative coagulation disorders can be reduced by 'bedside' ROTEM analysis to achieve a selective substitution management. Saved costs for blood- and coagulation products clearly outweighed the expenses of ROTEM. Adequate differential coagulation management can therefore be cost-effective.

Recombinant FVIIa decreases perioperative blood transfusion requirement in burn patients undergoing excision and skin grafting-Results of a single centre pilot study.
Burns. 2007 Mar 21; [Epub ahead of print] rFVIIa significantly decreased the total number of units of blood components transfused per patient and percentage full thickness burn wound excised compared with placebo (0.9 versus 2.2, p=0.0013) including significant fewer red blood cell units (0.5 versus 1.1, p=0.004). We further observed a trend towards improved graft survival (p=0.1) and a reduction in multiple organ failures (p=0.08) in the rFVIIa-treated group. There were no adverse events, in particular thromboembolic events.

Management of massive operative blood loss.
Minerva Anestesiol. 2007 Mar 24; [Epub ahead of print] The present article reviews pathomechanisms of coagulopathy in massive bleeding, as well as routine laboratory tests and viscoelastic point-of-care hemostasis monitoring as the diagnostic basis for therapeutic interventions.

Is the Use of rFVIIa Safe and Effective in Bleeding Neonates?: A Retrospective Series of 8 Cases.
J Pediatr Hematol Oncol. 2007 Mar;29(3):145-150.In this study, the hemostatic agent rFVIIa was well-tolerated and behaved in a safe and efficacious manner in all infants treated for life-threatening bleeding and coagulation disorders. Future prospective controlled trials are needed to determine the efficacy, safety, tolerability, and possibly the optimal dose and timing of rFVIIa administration.

[Life-threatening postpartum hemorrhage and recombinant activated factor rFVIIa NovoSeven((R)) use.]
J Gynecol Obstet Biol Reprod (Paris). 2007 Feb;36(1):78-82. Epub 2007 Jan 10. French. Recombinant activated factor VII is an interesting and promising haemostatic agent in the management of life-threatening postpartum haemorrhage unresponsive to conventional treatment.