Severe coagulopathy in fulminant hepatic failure (FHF) is difficult to correct by conventional means. However, recombinant activated factor VII (rFVIIa) is an anti-hemophilic factor, which has shown promise in treating coagulopathy in liver disease.
In this study, researchers from Charlottesville, Virginia, sought to compare rFVIIa in treating the coagulopathy of FHF, with conventional therapy.
|All patients administered recombinant activated factor VII had temporary correction of coagulopathy.|
The research team studied 15 patients with FHF, who met King's College criteria for orthotopic liver transplantation.
They administered fresh frozen plasma (FFP) only to 8 consecutive patients, while 7 consecutive patients were administered both FFP and rFVIIa (40 µg/kg intravenous bolus).
The team compared coagulopathy, amount of plasma infused, development of anasarca, ability to undergo intracranial pressure (ICP) transducer placement, bleeding complications, ability to undergo transplantation, and survival, between the 2 groups.
The team found that all patients administered rFVIIa had temporary correction of coagulopathy, compared to 0 in the FFP only group.
In addition, 100% of rFVIIa patients versus 38% of FFP only patients were able to have an ICP transducer placed. The rFVIIa group also had less anasarca.
Although, an equal number of patients underwent transplantation from each group, overall survival was better in the rFVIIa group.
Of the 7 patients in the rFVIIa group, 5 were administered 1 or more subsequent doses of rFVIIa after placement of the ICP monitor.
Dr Vanessa Shami’s team concluded, “That rFVIIa is effective in transiently correcting laboratory parameters of coagulopathy in patients with FHF”.
“It facilitates the performance of invasive procedures and is associated with less frequent anasarca compared with conventional therapy.”
“Our preliminary experience supports the need for further studies to define the optimal dosing, safety, and efficacy of rFVIIa in patients with FHF.”