Clinical situations may include:
(1) during or after cardiac surgery
(2) during or after transplantation
(3) liver failure
(4) after massive trauma
(5) following gunshot wounds
NOTE: Use of Factor VIIa in this setting is not currently FDA approved.
Preliminary management:
(1) Replacement of coagulation factors with FFP and cryoprecipitate.
(2) Replacement of platelets in thrombocytopenia.
(3) Correction of anemia with blood transfusions.
(4) If uremia present, dialysis.
(5) If there is a surgically correctable bleeding source, perform surgery.
If the bleeding is not controlled with the above steps or if the patient is bleeding into a life-threatening location, then consider infusion of rFVIIa.
Dose of rFVIIa: one 4.8 mg vial IV
If the patient responds to the rFVIIa infusion, then titrate the dose and dosing interval to maintain hemostasis.
If the person does not respond to the first dose of rFVIIa in 30 to 60 minutes, then a second dose can be given.
Patients may not respond to the rFVIIa infusions. This may occur with fulminant DIC or end-stage liver disease. In end-stage liver disease the ability to synthesize liver factors may be insufficient to maintain hemostasis.
