Use of Recombinant Factor VIIa in a Patient with Congenital Factor VII Deficiency

 

Factors affecting how to treat a Factor VII deficiency:

(1) bleeding into high risk areas (CNS, cardiothoracic, ophthalmic)

(2) severity of other bleeding

(3) cause of the bleeding (trauma or surgery vs spontaneous)

(4) Factor VII activity

(5) patient's tolerance to volume load

Factor VII Activity	Bleeding	Management
>= 25%	none	monitor patient
>= 25%	present	Factor VII therapy until controlled
< 25%	none	monitor patient closely, minimize risk for injury
< 25%	present	Factor VII therapy until controlled

 

Therapy is complicated due to the short half-life of factor VII (2-5 hours)

 

Therapy with fresh frozen plasma (FFP):

(1) initially 10-15 mL per kg

(2) maintenance 3-6 mL per kg every 6-8 hours until bleeding resolved

 

Therapy with rFVIIa:

(1) 20 micrograms per kg IV every 2 hours (roughly approximates one 1.2 mg vial).

(2) rFVIIa comes in 1.2, 2.4 and 4.8 mg vials.

 

Therapy with FFP and rFVIIa can be combined to meet the needs of the patient.