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Use of recombinant factor VIIa in massive post-partum haemorrhage

Published online by Cambridge University Press:  01 April 2008

R. C. N. McMorrow ,
S. M. Ryan ,
W. P. Blunnie ,
M. Bowen ,
E. G. Carton ,
J. Gardiner ,
M. Geary  and
J. P. R. Loughrey
R. C. N. McMorrow*
Affiliation:
Rotunda Hospital, Department of Anaesthetics, Dublin, Ireland
S. M. Ryan
Affiliation:
Rotunda Hospital, Department of Anaesthetics, Dublin, Ireland
W. P. Blunnie
Affiliation:
Rotunda Hospital, Department of Anaesthetics, Dublin, Ireland
M. Bowen
Affiliation:
Rotunda Hospital, Department of Anaesthetics, Dublin, Ireland
E. G. Carton
Affiliation:
Rotunda Hospital, Department of Anaesthetics, Dublin, Ireland
J. Gardiner
Affiliation:
Rotunda Hospital, Department of Anaesthetics, Dublin, Ireland
M. Geary
Affiliation:
Rotunda Hospital, Department of Obstetrics and Gynaecology, Dublin, Ireland
J. P. R. Loughrey
Affiliation:
Rotunda Hospital, Department of Anaesthetics, Dublin, Ireland
*
Roger C. N. McMorrow, Department of Anaesthetics, Rotunda Hospital, Parnell Square, Dublin 1, Ireland. E-mail: [email protected]; Tel: +353 18730700; Fax: +353 18730347
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Summary

Background and objective

Massive post-partum haemorrhage continues to be one of the world’s leading causes of maternal morbidity and mortality. Any new treatment that potentially helps at risk parturients should be thoroughly investigated. Recombinant factor VIIa (rVIIa) is increasingly being used in the treatment of massive haemorrhage. We performed a case-matched analysis of its use since 2003 in the treatment of massive post-partum haemorrhage at our hospital.

Methods

Twenty-eight cases of massive post-partum haemorrhage were identified over a 3-yr period since 2003. In six of these cases, rVIIa was used as part of their management. Six case-matched controls were sought. The six women with the greatest requirement for packed red cell transfusion who also had a deranged prothrombin time were included. The groups were then compared for differences. The worst prothrombin time in each group was noted as was the best prothrombin time within 6 h, this was used as our measure of response to treatment.

Results

There was no statistical difference in age, gestation, parity, transfusion requirements, mode of delivery or the severity of the coagulopathy between the two groups. In both groups the prothrombin time improved with management. There was no significant difference in either the magnitude of the improvement in the value of the prothrombin time or the absolute value of the best prothrombin time (P = 0.09). Five out of the six women in the rFVIIa group had normal or low prothrombin times within 6 h yet only one woman who did not receive rFVIIa had a normal prothrombin time within 6 h though this was not significant (P = 0.08).

Conclusions

This case-matched analysis supports the management of massive post-partum haemorrhage with appropriate resuscitation, surgical intervention and use of blood and blood products. This study does not support the routine use of rFVIIa in the management of massive obstetric haemorrhage. rFVIIa may have a role to play in this management but further studies and analyses will be required.

Keywords

POST-PARTUM HAEMORRHAGEFACTOR VII, recombinantPROTHROMBIN TIME
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 4 , April 2008 , pp. 293 - 298
Copyright
Copyright © European Society of Anaesthesiology 2008

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References

1. Maternal mortality in 2000: Estimates developed by WHO, UNICEFF and UNFPA. www.who.int/reproductive-health/publications/maternal_mortality_2000/mme.pdfGoogle Scholar
2. Khan KS, Wojdyla D, Say L, et al. WHO analysis of causes of maternal death: a systematic review. 2006; 367: 1066–74.Google Scholar
3.Combs, CA, Murphy, EL, JrLaros, RK. Factors associated with post-partum haemorrhage with vaginal birth. Obstet Gynecol 1991; 77: 69–76.Google ScholarPubMed
4.Stones, RW, Peterson, CM, Saunders, NJ. Risk factors for major obstetric haemorrhage. Eur J Obstet Gynecol Reprod Biol 1993; 48: 15–18.CrossRefGoogle ScholarPubMed
5.Confidential Enquiry into Maternal and Child Health. Why Mothers Die 2000–2002. London: RCOG Press, 2004.Google Scholar
6.Kenet, G, Walden, R, Eldad, A, Martinowitz, U. Treatment of traumatic bleeding with recombinant factor VIIa. Lancet 1999; 354: 1879.CrossRefGoogle ScholarPubMed
7.www.novoseven.comGoogle Scholar
8.Spahn, DR, Tucci, MA, Makris, M. Is recombinant FVIIa the magic bullet in the treatment of major bleeding? (Editorial). Br J Anaesth 2005; 94: 553–555.CrossRefGoogle Scholar
9.Allen, GA, Roberts, HR, 3rdMonroe, DM. Recombinant activated factor VII: its mechanism of action and role in the control of hemorrhage. Can J Anaesth 2002; 49: S7–S14.Google ScholarPubMed
10.Martinowitz, U, Holcomb, JB, Pusateri, AE et al. Intravenous rFVIIa administered for hemorrhage control in hypothermic coagulopathic swine with grade V liver injuries. J Trauma 2001; 50: 721–729.CrossRefGoogle ScholarPubMed
11.Ghorashian, S, Hunt, BJ. ‘Off-license’ use of recombinant activated factor VII. Blood Rev 2004; 18: 245–259.CrossRefGoogle ScholarPubMed
12.Ahonen, A, Jokela, R. Recombinant factor VIIa for life-threatening post-partum haemorrhage. Br J Anaesth 2005; 94: 592–595.CrossRefGoogle ScholarPubMed
13.Laffan, M, O’Connell, NM, Perry, DJ et al. Analysis and results of the recombinant factor VIIa extended-use registry. Blood Coagul Fibrinolysis 2003; 14: S35–S38.CrossRefGoogle ScholarPubMed
14.Meng, ZH, Wolberg, AS, 3rdMonroe, DM, Hoffman, M. The effect of temperature and pH on the activity of factor VIIa: implications for the efficacy of high-dose factor VIIa in hypothermic and acidotic patients. J Trauma 2003; 55: 886–891.CrossRefGoogle ScholarPubMed
15.Hollnberger, H, Gruber, E, Seelbach-Goebel, B. Major post-partum hemorrhage and treatment with recombinant factor VIIa. Anesth Analg 2005; 101: 1886–1887.CrossRefGoogle ScholarPubMed