Use of recombinant activated factor VII (rFVIIa-NovoSeven) in the treatment of uncontrolled postsurgical hemorrhage in a patient with deep venous thrombosis and caval filter. A case report

A 37-year-old woman affected by renal insufficiency was submitted to renal transplantation from cadaver donor. After a few days she had a severe and life-threatening hemorrhage at the surgical site and a deep venous thrombosis at her lower right limb. Since anticoagulant therapy was contraindicated, a filter was inserted in the inferior vena cava. After several red blood cell, fresh plasma and platelet transfusions, and after repeated unsuccessful surgical procedures, a single dose of 70 microg/kg of body weight of recombinant activated factor VII (rFVIIa) was administered as last resource. The drug was successful in obtaining the complete and rapid resolution of the hemorrhagic episode. Despite the patient had two factors which could have favoured a thrombotic complication, e.g. deep venous thrombosis and caval filter, administration of rFVIIa did not worsen the underlying thrombotic process. rFVIIa is a new hemostatic agent that was initially used in hemophiliac patients. Later it has been successfully used in nonhemophiliac patients to treat different inherited or acquired coagulation disorders. A potential thrombogenic effect of rFVIIa was hypothesized on the basis of some clinical case reports but large controlled trials do not exist. In this case report the use of rFVIIa was successful and safe despite the concomitant presence of several thrombogenic factors.