Correction of both prothrombin time and primary haemostasis by recombinantfactor VII during therapeutic alcohol injection of hepatocellular cancer in liver cirrhosis

We evaluated the efficacy of recombinant factor VII to correct impaired hae mostasis in a patient with liver cirrhosis requiring an invasive procedure, A test intravenous bolus of 80 mu g/kg of recombinant factor VII was given to a Jehovah's Witness, with a solitary 4.4 cm hepatocellular carcinoma an d underlying hepatitis C virus cirrhosis, in an attempt to correct his haem ostatic disorders and safely inject the tumour with alcohol. An extensive p ortal block had precluded con; sideration of liver transplantation. Haemost asis was evaluated by clotting assays, bleeding time and thromboelastograph y 10 min before and 10 min and 1, 2, 4, 8 and 24 h after factor VII infusio n. Parameters of both coagulation (prothrombin time) and platelet function (bleeding time and the a and Inn parameters of thrombelastography) were imp roved 10 min after factor VII infusion; improvements lasted 4 to 8 h or mor e. Platelet count did not change and there was no evidence of disseminated intravascular coagulation. The improvements in haemostatic parameters corre lated significantly with the increases in factor VII plasma concentrations (p<0.04), Factor VI clearance was 25.1 U/h/kg and its half-life was 5.8 h, The same dose of recombinant factor VII was:given to the patient 1 week lat er, just before the alcohol injections. The patient had no subsequent bleed ing or other complication, with no change in haemoglobin levels over 24 h, Thus, recombinant factor VII represents a therapeutic advance, as it can co rrect fully both coagulation and platelet function defects in cirrhosis and allow invasive procedures to de performed safely.