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J Thorac Cardiovasc Surg 2008;136:220-221
© 2008 The American Association for Thoracic Surgery

Brief Communication

Fatal thrombotic event after infusion of recombinant activated factor VII after cardiac surgery

N. Pichon, MDa,b,*, F. Bellec, MDa, S. Sekkal, MDc, J.P. Marsaud, MDd,e, M. Laskar, MD, PhDc,e, B. François, MDa,b, P. Vignon, MD, PhDa,b,e

a Medical-Surgical Intensive Care Unit, Dupuytren Teaching Hospital, Limoges, France
b Centre de Recherche Clinique, Dupuytren Teaching Hospital, Limoges, France
c Department of Thoracic and Cardiovascular Surgery, Dupuytren Teaching Hospital, Limoges, France
d Department of Anesthesiology, Dupuytren Teaching Hospital, Limoges, France
e University of Limoges, Limoges, France

Received for publication August 24, 2007; revisions received September 12, 2007; accepted for publication October 19, 2007.

* Address for reprints: Nicolas Pichon, MD, Intensive Care Unit, CHU Dupuytren, 2 avenue Martin Luther King, 87042 Limognes, France. (Email: nicolas.pichon@chu-limoges.fr).

The first 20% of the full text of this article appears below.

Hemorrhagic shock is a major complication of cardiothoracic surgery that occurs when standard surgical and medical hemostatic procedures fail to stop hemorrhage. Recombinant activated factor VII (rFVIIa; NovoSeven, Novo Nordisk, Denmark) is a prohemostatic agent increasingly used as rescue therapy in cardiothoracic surgery, but its safety in this indication remains to be investigated. We report a fatal thrombotic event that occurred within 48 hours after the administration of rFVIIa for a refractory hemorrhagic shock after cardiothoracic surgery.

Clinical Summary

A 57-year-old hypertensive male patient underwent an aortic valve and ascending aorta replacement (Carbo-Seal Valsalva Ascending Aortic Prosthesis CP-023; CarboMedics, Austin, Texas) for a type A aortic dissection including both carotid arteries without antegrade carotid perfusion (Go Figure 1). Postoperatively, the patient had severe hemorrhagic shock resulting from active bleeding from the chest tubes (10 mL · kg–1 · h–1), despite the transfusion of 2700 mL of blood from a cell salvage machine, 9 units of packed red blood cells (PRBC), 12 units of fresh-frozen plasma (FFP), 2 units of pooled platelet concentrates, 2 g of fibrinogen, and calcium chloride. The patient had a metabolic acidosis . . . [Full Text of this Article]






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