Year : 2016  |  Volume : 19  |  Issue : 3  |  Page : 418--424

Impact on postoperative bleeding and cost of recombinant activated factor VII in patients undergoing heart transplantation


Allison L Hollis1, Ashleigh V Lowery1, Mehrnaz Pajoumand1, Si M Pham2, Julia F Slejko3, Kenichi A Tanaka4, Michael Mazzeffi1 
1 Department of Pharmacy, University of Maryland Medical Center, Baltimore, MD 21201, USA
2 Department of Cardiothoracic Surgery, University of Maryland Medical Center, Baltimore, MD 21201, USA
3 School of Pharmacy, University of Maryland Medical Center, Baltimore, MD 21201, USA
4 Department of Anesthesiology, University of Maryland Medical Center, Baltimore, MD 21201, USA

Correspondence Address:
Michael Mazzeffi
University of Maryland Medical Center, 22, South Greene Street, Baltimore, MD 21201
USA

Background: Cardiac transplantation can be complicated by refractory hemorrhage particularly in cases where explantation of a ventricular assist device is necessary. Recombinant activated factor VII (rFVIIa) has been used to treat refractory bleeding in cardiac surgery patients, but little information is available on its efficacy or cost in heart transplant patients. Methods: Patients who had orthotopic heart transplantation between January 2009 and December 2014 at a single center were reviewed. Postoperative bleeding and the total costs of hemostatic therapies were compared between patients who received rFVIIa and those who did not. Propensity scores were created and used to control for the likelihood of receiving rFVIIa in order to reduce bias in our risk estimates. Results: Seventy-six patients underwent heart transplantation during the study period. Twenty-one patients (27.6%) received rFVIIa for refractory intraoperative bleeding. There was no difference in postoperative red blood cell transfusion, chest tube output, or surgical re-exploration between patients who received rFVIIa and those who did not, even after adjusting with the propensity score (P = 0.94, P = 0.60, and P = 0.10, respectively). The total cost for hemostatic therapies was significantly higher in the rFVIIa group (median $10,819 vs. $1,985; P < 0.0001). Subgroup analysis of patients who underwent redo-sternotomy with left ventricular assist device explantation did not show any benefit for rFVIIa either. Conclusions: In this relatively small cohort, rFVIIa use was not associated with decreased postoperative bleeding in patients undergoing heart transplantation; however, it led to significantly higher cost.


How to cite this article:
Hollis AL, Lowery AV, Pajoumand M, Pham SM, Slejko JF, Tanaka KA, Mazzeffi M. Impact on postoperative bleeding and cost of recombinant activated factor VII in patients undergoing heart transplantation.Ann Card Anaesth 2016;19:418-424


How to cite this URL:
Hollis AL, Lowery AV, Pajoumand M, Pham SM, Slejko JF, Tanaka KA, Mazzeffi M. Impact on postoperative bleeding and cost of recombinant activated factor VII in patients undergoing heart transplantation. Ann Card Anaesth [serial online] 2016 [cited 2020 Sep 29 ];19:418-424
Available from: http://www.annals.in/article.asp?issn=0971-9784;year=2016;volume=19;issue=3;spage=418;epage=424;aulast=Hollis;type=0