Journal article

The Danger of Using a Sledgehammer to Crack a Nut: ROTEM-Guided Administration of Recombinant Activated Factor VII in a Patient With Refractory Bleeding Post-Ventricular Assist Device Implantation

Vincenzo Tarzia, Edward Buratto, Giacomo Bortolussi, Carla Paolini, Jonida Bejko, Tomaso Bottio, Gino Gerosa

Artificial Organs | WILEY | Published : 2015

Abstract

Recombinant activated factor VII (rFVIIa) is currently approved for treating or preventing hemorrhage in patients with hemophilia, Glanzmann's thrombasthenia, or congenital FVII deficiency. Its "off-label" use for massive bleeding in the setting of trauma or surgery has been increasing because of demonstrated efficacy. However, the use of rFVIIa also carries a high thrombo-embolic risk. This is particularly true in cardiac surgery patients, especially those treated with mechanical circulatory support. We describe the case of a patient treated with a biventricular assist device in our center, in whom severe bleeding was treated in a targeted manner, using rotational thromboelastometry to guid..

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