An open non-randomized study of recombinant activated factor VII in major postpartum haemorrhage

Acta Anaesthesiol Scand. 2007 Aug;51(7):929-36. doi: 10.1111/j.1399-6576.2007.01323.x. Epub 2007 May 4.

Abstract

Background: Empirical off-label use of recombinant activated factor VII (rFVIIa) has been reported to be effective in some cases of severe postpartum haemorrhage (PPH). Successful management of these patients has lead to more wide-spread use of rFVIIa in less severe cases without any evidence for the advantages of its administration.

Methods: Until November 2006, we had administered rFVIIa to 38 parturients. Based on our initial experience with the first 12 patients, we prepared guidelines for the use of rFVIIa. During the existence of these guidelines, we made a retrospective comparison of the 26 women who received rFVIIa with another 22 women who were treated during the same time period without using rFVIIa.

Results: The total amount of blood loss was significantly higher (11.3 +/- 4.5 vs. 8.0 +/- 3.1 l), and the coagulation screen revealed significantly longer partial thromboplastin time (APTT) and prothrombin time (PT) values and significantly lower fibrinogen values in patients receiving rFVIIa. The need for red blood cells, platelets and fibrinogen concentrate was significantly higher in these women. Although the response was considered good in two-thirds of the women, several patients received rFVIIa with a poor or no response as a result of arterial bleeding.

Conclusion: The decision to use rFVIIa resulted from a more profound haemorrhage. We did not gain any evidence to extend the use of rFVIIa into less severe cases of PPH. Furthermore, this policy would result in a profound increase in the overall costs of the treatment. Randomized placebo-controlled trials are urgently needed to optimize the use of rFVIIa in obstetric haemorrhage.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Blood Gas Analysis
  • Blood Transfusion
  • Factor VII / therapeutic use*
  • Female
  • Fibrinogen / metabolism
  • Humans
  • Partial Thromboplastin Time
  • Postpartum Hemorrhage / drug therapy*
  • Pregnancy
  • Prothrombin Time
  • Pulmonary Alveoli / metabolism
  • Pulmonary Edema / pathology
  • Recombinant Proteins / therapeutic use
  • Retrospective Studies
  • Vagina / injuries
  • Vagina / surgery

Substances

  • Recombinant Proteins
  • Factor VII
  • Fibrinogen