Background: Recombinant factor VIIa is a general hemostatic agent. Randomized trials have demonstrated effectiveness in adults; however, data in children are confined to case reports and series subject to publication bias.
Procedures: A consecutive cohort of children treated with rFVIIa was identified via inspection of pharmacy records. Data collected included demographic data, underlying disorders, reason for rFVIIa use, dosing, thrombotic events, and mortality. Efficacy was scored subjectively on a 3-point scale (complete, partial, or no response) and supported by a measurement of transfusion of red cells, platelets, fresh frozen plasma, and cryoprecipitate in the 3 days prior to and following use of rFVIIa. Patients with hemophilia and congenital factor VII deficiency were excluded.
Results: Sixty-five percent had a complete response and 26% had a partial response. Following treatment, there was a mean reduction in transfusions of 14.2 ml/kg for red blood cells, 10.9 ml/kg for platelets, 9 ml/kg for fresh frozen plasma, and 4.6 ml/kg for cryoprecipitate. Thrombosis occurred in 4.3% of patients with the highest rate being in neonates (17.6%).
Conclusions: rFVIIa is an effective general hemostatic agent for management of excessive bleeding in children and that with the exception of neonates has excellent safety.
(c) 2009 Wiley-Liss, Inc.