Activated recombinant factor VII in cardiac surgery

Purpose of review: Severe bleeding after cardiac surgery is a potential problem that poses major risks and challenges. Severe bleeding after cardiac surgery still occurs despite many pharmacological approaches to decrease bleeding and reduce transfusion requirements. Activated recombinant factor VII may be a therapy that is potentially useful in the management of refractory bleeding after cardiac surgery and in other postoperative bleeding states. Recent findings: Several small, uncontrolled case series have suggested that activated recombinant factor VII may be useful in the management of some patients with intractable bleeding after cardiopulmonary bypass in both pediatric and adult populations. Blood loss or transfusion requirements have been reported to be substantially reduced in some patients who receive activated recombinant factor VII perioperatively. However, these reports have not established the optimal dosing or ideal timing of the administration of activated recombinant factor VII, or determined the frequency of serious adverse events related to its use. Summary: Current reports summarized in this review suggest that activated recombinant factor VII may be a promising agent in the management of uncontrolled bleeding after cardiopulmonary bypass, but additional randomized, placebo-controlled trials are needed to support this use.