Recombinant factor VIIa improves coagulopathy caused by liver failure

Jeffrey B Brown, Karan M. Emerick, Deborah L. Brown, Peter F Whitington, Estella M Alonso*

*Corresponding author for this work

Research output: Contribution to journalReview article

69 Citations (Scopus)

Abstract

Objective: Coagulopathy is an important cause of morbidity and mortality in patients with liver failure. The benefit of traditional therapies to correct coagulation is often limited and short-lived. Our aim is to identify indications for rFVIIa use and the outcome of treatment in children with liver failure. Methods: A retrospective review from July 2000 to December 2001 was performed to identify consecutive patients with acute or chronic liver failure who received rFVIIa. Prothrombin times (PT) before and after therapy were compared by paired t test. Results: Fifteen patients were treated with rFVIIa for coagulopathy caused by liver failure. All were receiving fresh frozen plasma (mean infusion rate, 39.7 mL/kg/day) when rFVIIa therapy was started. The mean PT before rFVIIa was 32.0 ± 7.0 seconds. One hour after infusion, the PT normalized to 13.7 ± 2.4 seconds (P < 0.0001) and remained significantly reduced at 6 hours (19.8 ± 5.3 seconds; P < 0.0001). A sustained improvement was maintained during the subsequent 3 days. Five of seven patients with bleeding complications improved clinically after rFVIIa treatment. Two of the bleeding patients also benefited from improved fluid balance as fresh frozen plasma support was reduced. No thrombotic events were attributed to rFVIIa therapy. Conclusions: In patients with liver failure, rFVIIa therapy quickly normalizes the PT and maintains improved hemostasis, even when coagulopathy has been refractory to fresh frozen plasma. Therapy subjectively reduces clinical bleeding and can improve fluid balance, without complications.

Original languageEnglish (US)
Pages (from-to)268-272
Number of pages5
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume37
Issue number3
DOIs
StatePublished - Sep 1 2003

Fingerprint

Liver Failure
Prothrombin Time
Water-Electrolyte Balance
Hemorrhage
Therapeutics
End Stage Liver Disease
Acute Liver Failure
recombinant FVIIa
Hemostasis
Morbidity
Mortality

Keywords

  • Coagulopathy
  • Liver failure
  • Recombinant FVIIa

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Medicine(all)
  • Gastroenterology

Cite this

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title = "Recombinant factor VIIa improves coagulopathy caused by liver failure",
abstract = "Objective: Coagulopathy is an important cause of morbidity and mortality in patients with liver failure. The benefit of traditional therapies to correct coagulation is often limited and short-lived. Our aim is to identify indications for rFVIIa use and the outcome of treatment in children with liver failure. Methods: A retrospective review from July 2000 to December 2001 was performed to identify consecutive patients with acute or chronic liver failure who received rFVIIa. Prothrombin times (PT) before and after therapy were compared by paired t test. Results: Fifteen patients were treated with rFVIIa for coagulopathy caused by liver failure. All were receiving fresh frozen plasma (mean infusion rate, 39.7 mL/kg/day) when rFVIIa therapy was started. The mean PT before rFVIIa was 32.0 ± 7.0 seconds. One hour after infusion, the PT normalized to 13.7 ± 2.4 seconds (P < 0.0001) and remained significantly reduced at 6 hours (19.8 ± 5.3 seconds; P < 0.0001). A sustained improvement was maintained during the subsequent 3 days. Five of seven patients with bleeding complications improved clinically after rFVIIa treatment. Two of the bleeding patients also benefited from improved fluid balance as fresh frozen plasma support was reduced. No thrombotic events were attributed to rFVIIa therapy. Conclusions: In patients with liver failure, rFVIIa therapy quickly normalizes the PT and maintains improved hemostasis, even when coagulopathy has been refractory to fresh frozen plasma. Therapy subjectively reduces clinical bleeding and can improve fluid balance, without complications.",
keywords = "Coagulopathy, Liver failure, Recombinant FVIIa",
author = "Brown, {Jeffrey B} and Emerick, {Karan M.} and Brown, {Deborah L.} and Whitington, {Peter F} and Alonso, {Estella M}",
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Recombinant factor VIIa improves coagulopathy caused by liver failure. / Brown, Jeffrey B; Emerick, Karan M.; Brown, Deborah L.; Whitington, Peter F; Alonso, Estella M.

In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 37, No. 3, 01.09.2003, p. 268-272.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Recombinant factor VIIa improves coagulopathy caused by liver failure

AU - Brown, Jeffrey B

AU - Emerick, Karan M.

AU - Brown, Deborah L.

AU - Whitington, Peter F

AU - Alonso, Estella M

PY - 2003/9/1

Y1 - 2003/9/1

N2 - Objective: Coagulopathy is an important cause of morbidity and mortality in patients with liver failure. The benefit of traditional therapies to correct coagulation is often limited and short-lived. Our aim is to identify indications for rFVIIa use and the outcome of treatment in children with liver failure. Methods: A retrospective review from July 2000 to December 2001 was performed to identify consecutive patients with acute or chronic liver failure who received rFVIIa. Prothrombin times (PT) before and after therapy were compared by paired t test. Results: Fifteen patients were treated with rFVIIa for coagulopathy caused by liver failure. All were receiving fresh frozen plasma (mean infusion rate, 39.7 mL/kg/day) when rFVIIa therapy was started. The mean PT before rFVIIa was 32.0 ± 7.0 seconds. One hour after infusion, the PT normalized to 13.7 ± 2.4 seconds (P < 0.0001) and remained significantly reduced at 6 hours (19.8 ± 5.3 seconds; P < 0.0001). A sustained improvement was maintained during the subsequent 3 days. Five of seven patients with bleeding complications improved clinically after rFVIIa treatment. Two of the bleeding patients also benefited from improved fluid balance as fresh frozen plasma support was reduced. No thrombotic events were attributed to rFVIIa therapy. Conclusions: In patients with liver failure, rFVIIa therapy quickly normalizes the PT and maintains improved hemostasis, even when coagulopathy has been refractory to fresh frozen plasma. Therapy subjectively reduces clinical bleeding and can improve fluid balance, without complications.

AB - Objective: Coagulopathy is an important cause of morbidity and mortality in patients with liver failure. The benefit of traditional therapies to correct coagulation is often limited and short-lived. Our aim is to identify indications for rFVIIa use and the outcome of treatment in children with liver failure. Methods: A retrospective review from July 2000 to December 2001 was performed to identify consecutive patients with acute or chronic liver failure who received rFVIIa. Prothrombin times (PT) before and after therapy were compared by paired t test. Results: Fifteen patients were treated with rFVIIa for coagulopathy caused by liver failure. All were receiving fresh frozen plasma (mean infusion rate, 39.7 mL/kg/day) when rFVIIa therapy was started. The mean PT before rFVIIa was 32.0 ± 7.0 seconds. One hour after infusion, the PT normalized to 13.7 ± 2.4 seconds (P < 0.0001) and remained significantly reduced at 6 hours (19.8 ± 5.3 seconds; P < 0.0001). A sustained improvement was maintained during the subsequent 3 days. Five of seven patients with bleeding complications improved clinically after rFVIIa treatment. Two of the bleeding patients also benefited from improved fluid balance as fresh frozen plasma support was reduced. No thrombotic events were attributed to rFVIIa therapy. Conclusions: In patients with liver failure, rFVIIa therapy quickly normalizes the PT and maintains improved hemostasis, even when coagulopathy has been refractory to fresh frozen plasma. Therapy subjectively reduces clinical bleeding and can improve fluid balance, without complications.

KW - Coagulopathy

KW - Liver failure

KW - Recombinant FVIIa

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U2 - 10.1097/00005176-200309000-00013

DO - 10.1097/00005176-200309000-00013

M3 - Review article

C2 - 12960648

AN - SCOPUS:1542681456

VL - 37

SP - 268

EP - 272

JO - Journal of Pediatric Gastroenterology and Nutrition

JF - Journal of Pediatric Gastroenterology and Nutrition

SN - 0277-2116

IS - 3

ER -