Predicting response to recombinant factor VIIa in non-haemophiliac patients with severe haemorrhage

Background. Despite increasing use of recombinant factor VIIa(rFVIIa) in non-haemophiliac patients, it is unclear when rFVIIamight be effective. Methods. A single centre review of consecutive non-haemophiliacpatients receiving rFVIIa for the management of severe haemorrhage.Treatments with rFVIIa were at a dose of 90 µg kg^–1repeated at three hourly intervals at the clinicians' discretion. Results. Eighteen patients received rFVIIa. Six patients survivedto discharge and 12 patients died in hospital. The median (range)Sequential Organ Failure Assessment (SOFA) score at the timeof administration of rFVIIa for the group that survived was8.0 (5–12) compared with the group that died 12.0 (7.0–14.0)(P=0.03). One of the patients who survived (17%) had organ failureat the time of rFVIIa administration compared with 11 of thosewho died (92%) (P=0.004). Fifteen patients survived long enoughto consider a second dose of rFVIIa, one patient who survivedto discharge needed more than one dose (1/6, 17%), comparedwith seven of those who later died in hospital (7/9, 78%) (P=0.04).The survivors had a significant reduction in blood product requirementsafter rFVIIa, while patients who died did not. Neither the prothrombintime nor the activated partial thromboplastin time before orafter rFVIIa predicted survival. Conclusions. High SOFA score and failure to respond to one adequatedose of rFVIIa appear to identify patients with poor prognosis.These observations may help in determining when rFVIIa treatmentis likely to be futile.