Clinical Outcomes of Recombinant Activated Factor VII (rVIIa) Use in a Tertiary Care Hospital: 70 Treatment Courses in 63 Patients.

rVIIa was originally developed and released for use in hemophilia patients with inhibitors. Recently the suggested uses for rVIIa have expanded dramatically. However, most of the data on the novel uses of rVIIa have been published as case reports or limited series. We reviewed our inpatient experience with rVIIa over the past 4 years. Diagnoses included CNS bleeding (12 of 14 on warfarin), inherited coagulation defects (2 patients with Glanzmann’s thrombasthenia (GT), one with factor VII deficiency and one with XI deficiency), inhibitors (1 hemophilia A, 2 hemophilia B, and 8 acquired factor VIII). “Last ditch” included 4 patients bleeding from severe GVHD after stem cell transplant, 3 cases of refractory sepsis, bleeding due to pulmonary hypertension, and CNS bleed due to tumor), surgery (4 of 7 cardiac) and trauma. 6 patients (2 inhibitor, 1 surgery, and 3 inherited) received more than one course of rVIIa. The average dose was 90 ug/kg. Overall 42 patients (60%) were alive at discharge with the congenital coagulation deficient and acquired inhibitor patients having 100% survival. Patients with liver disease or those patients given rVIIa as a “last resort” had the worst survivals despite being effective for controlling bleeding in most patients. rVIIa is effective for patients with GT, factor deficiencies, or inhibitors and its use is associated with good outcomes. In patients with bleeding due to their underlying medical problems, rVIIa was modestly effective at controlling bleeding. However, their outcomes were determined by the survivability of their disease process. For effective use of rVIIa patient selection appears to be crucial.