PMID- 35411145
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220413
IS  - 1176-6336 (Print)
IS  - 1178-203X (Electronic)
IS  - 1176-6336 (Linking)
VI  - 18
DP  - 2022
TI  - Recombinant Activated Factor VII in Aortic Surgery for Patients Under Hypothermic 
      Circulatory Arrest.
PG  - 337-348
LID - 10.2147/TCRM.S352609 [doi]
AB  - PURPOSE: We aimed to identify the risk factors of critical bleeding and 
      investigate the safety of recombinant activated factor VII (rFVIIa) in aortic 
      surgery under hypothermic circulatory arrest (HCA). PATIENTS AND METHODS: The 
      present single-center retrospective study compared the baseline characteristics 
      of 144 patients who underwent aortic surgery under HCA at our institute. Among 
      the total cohort of 144 patients, 42 received rFVIIa (rFVIIa group), while the 
      remaining 102 patients did not (non-rFVIIa group). Perioperative bleeding and 
      transfusions, postoperative 30-day mortality, and adverse events (AEs) were 
      analyzed in 29 propensity score-matched pairs. RESULTS: Before surgery, the 
      rFVIIa group demonstrated a greater number of shocks (p=0.019), higher JapanSCORE 
      II mortality rate (p=0.033), low platelet count (p=0.015) and fibrinogen 
      (p<0.001) level, prolonged activated partial thromboplastin time (aPTT) (p=0.005) 
      and prothrombin time international normalized ratio (PT-INR) (p=0.006), and 
      longer aortic cross clamp time (p=0.049). Postoperative bleeding, transfusion, 
      30-day mortality, and AEs were comparable between the groups both in the 
      entire-unmatched cohort and propensity score matching cohort. CONCLUSION: 
      Preoperative shock, higher JapanSCORE II mortality rates, low platelet and 
      fibrinogen levels, prolonged aPTT and PT-INR, and longer aortic clamping time 
      might be risk factors for excessive bleeding and indicate the need for rFVIIa 
      treatment. The present study suggests that rFVIIa can be safely used to address 
      critical and continuous bleeding in spite of adequate transfusion and 
      supplementation of other coagulation factors in aortic surgery under HCA, without 
      an increase in 30-day mortality and AEs.
CI  - (c) 2022 Ise et al.
FAU - Ise, Hayato
AU  - Ise H
AUID- ORCID: 0000-0001-7084-5429
AD  - Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan.
AD  - Department of Cardiovascular Surgery, Heinrich Heine University, Dusseldorf, 
      Germany.
FAU - Ushioda, Ryohei
AU  - Ushioda R
AD  - Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan.
FAU - Kanda, Hirotsugu
AU  - Kanda H
AD  - Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical 
      University, Asahikawa, Japan.
FAU - Kimura, Fumiaki
AU  - Kimura F
AD  - Department of Cardiovascular Surgery, Kushiro Kojinkai Memorial Hospital, 
      Kushiro, Japan.
FAU - Saijo, Yasuaki
AU  - Saijo Y
AD  - Division of Public Health and Epidemiology, Department of Social Medicine, 
      Asahikawa Medical University, Asahikawa, Japan.
FAU - Akhyari, Payam
AU  - Akhyari P
AD  - Department of Cardiovascular Surgery, Heinrich Heine University, Dusseldorf, 
      Germany.
FAU - Lichtenberg, Artur
AU  - Lichtenberg A
AD  - Department of Cardiovascular Surgery, Heinrich Heine University, Dusseldorf, 
      Germany.
FAU - Kamiya, Hiroyuki
AU  - Kamiya H
AD  - Department of Cardiac Surgery, Asahikawa Medical University, Asahikawa, Japan.
LA  - eng
PT  - Journal Article
DEP - 20220405
PL  - New Zealand
TA  - Ther Clin Risk Manag
JT  - Therapeutics and clinical risk management
JID - 101253281
PMC - PMC8994620
OTO - NOTNLM
OT  - aortic surgery under hypothermic circulatory arrest
OT  - cardiac surgery
OT  - recombinant activated factor VII
OT  - retrospective study
OT  - uncontrollable bleeding
COIS- Payam Akhyari reveived speaker honoraria from Abiomed, Jotec-Cryolife, and 
      Medtronic, reports grants and as the clinical study principal investigator for 
      Edwards Lifesciences and Abbott, outside the submitted work. The authors declare 
      that they have no other competing interests in this work.
EDAT- 2022/04/13 06:00
MHDA- 2022/04/13 06:01
PMCR- 2022/04/05
CRDT- 2022/04/12 05:30
PHST- 2021/12/05 00:00 [received]
PHST- 2022/03/15 00:00 [accepted]
PHST- 2022/04/12 05:30 [entrez]
PHST- 2022/04/13 06:00 [pubmed]
PHST- 2022/04/13 06:01 [medline]
PHST- 2022/04/05 00:00 [pmc-release]
AID - 352609 [pii]
AID - 10.2147/TCRM.S352609 [doi]
PST - epublish
SO  - Ther Clin Risk Manag. 2022 Apr 5;18:337-348. doi: 10.2147/TCRM.S352609. 
      eCollection 2022.