Factor VII for OHS

[grandmawrinkle]

Anyone ever given this?

I work in a multispecialty SICU that also includes CV surgery patients. For uncontrolled bleeding, our MDs will order Factor VII infrequently. I think I see it about once a month. Have you all seen this used, and if so, what was the outcome? Did they end up going back to the OR anyway?

My opinion is mixed. There are those few patients that are clearly hemorrhaging that it doesn't help because something didn't get sewed up and they just need to be re-opped and fixed. The others -- we have already thrown so much FFP, platelets, cryo, probably protamine at them that by the time they stop bleeding, I haven't been able to tell if it's an effect from all that or truly from the Factor VII.

I have seen it really work with I think maybe two patients, and they were both chronic hepatitis patients and coagulopathic with some degree of liver failure where it helped instantly.

[ghillbert, MSN, NP]

Used it in some pts with ventricular assist devices who had uncontrolled postop bleeding.. always made me nervous that they'd clot off the pumps but seemed to work well as a last resort.

[meandragonbrett]

In OHS patients? Never used it. In our trauma patients? Use it on a regular basis.

OHS patients usually have a reason they're bleeding such as needing to be stitched up. Factor VII isn't going to patch that hole up!

I would say that you aren't gonna see a whole lot of effect if the bleeding is caused from a mechanical issue rather than a clotting cascade issue.

[grandmawrinkle]

I would say that you aren't gonna see a whole lot of effect if the bleeding is caused from a mechanical issue rather than a clotting cascade issue.

I agree with you. I think our CV surgeons have seen it work a handful of times when it truly was a clotting issue and now they think it's the bee's knees, which is unfortunate because my understanding is that it is in the thousands of dollars per dose.

That is interesting that it is used in trauma. Thank you for posting, I always like to get a different perspective and learn a few new things on here.

[sunnycalifRN]

We use FEIBA, for our hearts, that are bleeders (only seen it used 4 times in the past year). The CT surgeon explained that it is generalized oozing from the sutures that doesn't stop, that warrants use of FEIBA. However, we don't give it, it's usually given in the OR. Apparently, it is very expensive.