Thursday April 8, 2010
Factor-7 in GI bleed


Case; 67 year old male admitted with acute GI bleed seconday to coumadin (warfarin) overdose with INR more than 7. You ordered, pRBC, FFP (fresh frozen plasma) and IV vitamin K. But you are afraid that patient may not survive before all the infusions are available. What could be your choice in such desperation?



A; recombinant FVIIa (Novo seven)

In many anecdotal reports (see references), novoseven has showed very quick reversal of PT / INR.



References:

1. Recombinant factor VIIa corrects prothrombin time in cirrhotic patients: A preliminary study: Gastroenterology 113:1930-1937, 1997

2. Recombinant factor VIIa (rFVIIa) successfully and rapidly corrects the excessively high international normalized ratios (INR) and prothrombin times induced by warfarin. Blood 96 (11 Part 1): 638a, 2000

3. Reversal of Warfarin-Induced Excessive Anticoagulation with Recombinant Human Factor VIIa Concentrate. Ann Inter Med. 137:884-888, 2002

4. Hemorrhagic complication of thrombocytopenia and oral anticoagulant: Is there a role for recombinant activated factor VII ?. Intensive Care Med 28 (Suppl 2):S228, 2002