A Critical Review on the Use of Recombinant Factor VIIa in Life-Threatening Obstetric Postpartum Hemorrhage

Massimo Franchini; Massimo Franchi; Valentino Bergamini; Gian Luca Salvagno; Martina Montagnana; Giuseppe Lippi

doi:10.1055/s-2008-1066022

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2008; 34(1): 104-112
DOI: 10.1055/s-2008-1066022

A Critical Review on the Use of Recombinant Factor VIIa in Life-Threatening Obstetric Postpartum Hemorrhage

Massimo Franchini¹ , Massimo Franchi² , Valentino Bergamini² , Gian Luca Salvagno³ , Martina Montagnana³ , Giuseppe Lippi³

¹Servizio di Immunoematologia e Trasfusione - Centro Emofilia, Azienda Ospedaliera di Verona, Verona; Italy
²Dipartimento Materno Infantile e di Biologia-Genetica, Sezione di Ginecologia e Ostetricia, Università di Verona, Verona; Italy
³Istituto di Chimica e Microscopia Clinica, Dipartimento di Scienze Biomediche e Morfologiche, Università di Verona, Verona; Italy

Abstract

ABSTRACT

The objective of this review was to evaluate and summarize the current literature on the unlicensed use of the novel agent recombinant activated factor VII (rFVIIa) in the management of major postpartum hemorrhage. After a systematic electronic search without temporal limits on MEDLINE, EMBASE, OVID and SCOPUS, the bibliographic references of all retrieved studies and reviews were additionally assessed for further reports of clinical trials. Unpublished works were also identified by searching abstracts from the most eminent conferences on this topic. In total, there were 31 studies that fulfilled our inclusion criteria. These studies incorporated 118 cases of massive postpartum hemorrhage treated with rFVIIa. The median age of the patients was 31.4 years, and cesarean section appeared to increase the risk of postpartum hemorrhage. At a median dose of 71.6 μg/kg, rFVIIa was reported to be effective in stopping or reducing bleeding in nearly 90% of the reported cases. Based on the evidence from the literature, we give some recommendations on the use of rFVIIa in massive postpartum hemorrhage. Nevertheless, although these reports suggest the potential role of rFVIIa in treating massive postpartum hemorrhage refractory to standard therapy, we advise particular caution in interpreting these results, as they are derived from few and uncontrolled studies. Further evidence is needed using well-designed clinical trials to better assess the optimal dose, the effectiveness, and the safety of rFVIIa in such critical bleeding conditions.

KEYWORDS

Postpartum hemorrhage - obstetrics - gynecology - bleeding - rFVIIa

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References

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Massimo FranchiniM.D.

Servizio di Immunoematologia e Trasfusione - Centro Emofilia, Ospedale Policlinico

Piazzale L. Scuro, 10 - 37134 Verona, Italy

Email: massimo.franchini@azosp.vr.it