Prophylactic Application Of Recombinant Activated Factor Ⅶ In Aortic Surgery

Massive bleeding is a major cause of morbidity and mortality in cardiovascular surgery. Recombinant activated factor Ⅶ(rFⅦa) provides an alternative to postoperative bleeding. Studies about rFⅦa in cardiac surgery focused on the usage in ICU. Herein we report our experience with the prophylactic use of rFWa in aortic surgery.This review defined 446 patients who received aortic surgery from May 2013 to July 2014 in the same ward. Excluding the rFⅦa group that can’t be matched, we matched a total of 75 patients with similar preoperative and intraoperative characteristics:rFⅦa group(n=25) and non-rFⅦa group(n=50). All patients in treatment group received one-time dose rFⅦa after the neutralization of heparin without evidence of bleeding. Perioperative data were collected to compare efficacy, safety and economic outcomes. Mann-Whitney or t-test and X2-test were used to assess significance.Matched patients had similar demographic and surgical feature. Average dose of rFⅦ a group was 28±9 μg·kg-1. The rFⅦa group had a significant decrease in the use of prothrombin complex concentrates(PCC) compared with control group(368 vs 748, P=0.007). There was no significant difference in use of other blood product, hemostatic agents, chest tube output, clinical outcomes, cost, and adverse events.This study shows that prophylactic use of low dose rFⅦa doesn’t have a positive effect on efficacy, safety and cost aspect compared with the control group. Result may be due to simple rFⅦa administration, low dosage, deficiency of PCC, or timing of rFⅦa usage. Whether the prophylactic use of rFⅦa is better for aortic surgery patients needs well-designed prospective randomized controlled trials to prove.