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Recombinant factor VIIa as a rescue therapy in severe haemoptysis in a patient with a Fontan circulation

Part of: Functionally Univentricular Heart

Published online by Cambridge University Press:  11 September 2017

Thomas W. Mason ,
Andrew Retter  and
Gareth J. Morgan
Thomas W. Mason
Affiliation:
Critical Care, St Thomas’ Hospital, Guys and St Thomas’ NHS foundation trust, London, United Kingdom
Andrew Retter*
Affiliation:
Critical Care, St Thomas’ Hospital, Guys and St Thomas’ NHS foundation trust, London, United Kingdom
Gareth J. Morgan
Affiliation:
Adult Congenital Cardiology, St Thomas’ Hospital, Guys and St Thomas’ NHS foundation trust, London, United Kingdom
*
Correspondence to: A. Retter, Critical Care, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom. Tel: +020 7188 7188, ext 54509; Fax: +44 2071887345; E-mail: [email protected]
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Abstract

We describe the successful use of recombinant factor VIIa (rFVIIa) in the control of massive haemoptysis in a 17-year-old patient with a Fontan circulation. The patient was intubated and ventilated in the ICU with deteriorating gas exchange. Conventional methods to control the haemoptysis were ineffective, and rFVIIa was successfully administered as a rescue therapy. rFVIIa is a powerful pro-thrombotic agent, which is only licensed in haemophiliacs with acquired inhibitors to anticoagulation. It has been used off-license in the treatment of massive haemorrhage, although a Cochrane review did not show any significant benefit; however, it may have a role as a rescue therapy where alternatives options have been exhausted after careful risk–benefit analysis.

Keywords

FontanrFVIIafactor VIIahaemoptysis
Type
Brief Report
Information
Cardiology in the Young , Volume 28 , Issue 1 , January 2018 , pp. 144 - 146
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Copyright
© Cambridge University Press 2017 

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References

1. McRae, ME. Long-term issues after Fontan procedure. AACN Adv Crit Care 2013; 24: 264–288.CrossRefGoogle ScholarPubMed
2. Bedard, E, Lopez, S, Perron, J, et al. Life-threatening hemoptysis following the Fontan procedure. Can J Cardiol 2008; 24: 145–147.CrossRefGoogle ScholarPubMed
3. Kenet, G, Walden, R, Eldad, A, Martinowitz, U. Treatment of traumatic bleeding with recombinant factor VIIa. Lancet 1999; 354: 1879.CrossRefGoogle ScholarPubMed
4. Ferraris, V, Brown, J, Despotis, G, et al. Update to The Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists, blood conservation clinical practice guidelines. Special report: STS workforce on evidence based surgery. Ann Thorac Surg 2011; 91: 944–982.CrossRefGoogle Scholar
5. Simpson, E, Lin, Y, Stanworth, S, Birchall, J, Doree, C, Hyde, C. Recombinant factor VIIa for the prevention and treatment of bleeding in patients without haemophilia. Cochrane Database Syst Rev 2012; issue 3: CD005011.CrossRefGoogle Scholar