Impact of early, low dose Factor VIIa on subsequent transfus
Recombinant Factor VII (rFVIIa) is used to treat cardiac surgical bleeding in an off-label manner. However, optimal dosing and timing of administration remains unknown in order to provide efficacious, yet safe outcomes.

In this retrospective, observational study, cardiac surgical patients (n=214) who received low dose rFVIIa for cardiac surgical bleeding.

Patients were allocated into one of three groups based on timing of rFVIIa administration during the course of bleeding resuscitation based on the number of hemostatic products given prior to rFVIIa administration: Group 1=less than 1 products (n=82); Group 2=2-4 products (n=73); Group 3= more than 5 products (n=59).

Patients who received low dose rFVIIa later in the course of bleeding resuscitation (Group 3) had longer ICU stay and increased incidence of postoperative renal failure when compared with Group 1. Total transfusions were lowest in patients who received rFVIIa early in the course of resuscitation (Group 1) (IQR 2(1-4.75)) and highest in Group 3 (IQR 11(8-14). Subsequent blood product transfusions after rFVIIa administration were highest in Group 2, however the median for all three groups was 2 products. There were no differences in thrombosis, reexplorations or mortality in any of the groups.

Conclusively, this study identified no differences in adverse outcomes based on timing of administration of low dose rFVIIa for cardiac surgical bleeding defined by stage of resuscitation, but benefits of early administration remain unclear.