An effective treatment of severe intractable bleeding after valve repair by one single dose of activated recombinant factor VII

Excessive bleeding (>2 L) after cardiac surgery is encountered in 3% to 7% of patients (1), and necessitates reexploration in 3.6% (2) to 4.2% (3) of cases. A variety of hemostatic defects may contribute and are probably indu ced by cardiopulmonary bypass (CPB), i.e., impaired platelet function, thro mbocytopenia, hyperfibrinolysis, heparin effect, protamine excess, and defi ciencies of coagulation factors (4,5). Platelet concentrates and plasma pro ducts, as well as drugs such as aprotinin and desmopressin, are administere d to improve hemostasis. Nevertheless, excessive bleeding persists in some patients. Recombinant factor VIIa (rFVIIa, NovoSeven(R), NovoNordisk, Copenhagen, Den mark) is a potentially effective hemostatic drug. Its beneficial effect was demonstrated in hemophilia patients with inhibitors to factor VIII or IX ( 6), and it has been suggested in a growing variety of hemostatic disorders such as thrombocytopenia, thrombocytopathia (7), and disorders related to l iver disease (8). We describe a patient who experienced intractable bleedin g after heart valve repair with successful treatment using rFVIIa.