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

  • Thomas W. Mason (a1), Andrew Retter (a1) and Gareth J. Morgan (a2)

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.

Copyright

Corresponding author

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: andrew.retter@gstt.nhs.uk

References

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2. Bedard, E, Lopez, S, Perron, J, et al. Life-threatening hemoptysis following the Fontan procedure. Can J Cardiol 2008; 24: 145147.
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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: 944982.
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.

Keywords

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

  • Thomas W. Mason (a1), Andrew Retter (a1) and Gareth J. Morgan (a2)

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