MEDICRIT Revista de Medicina Crítica, Vol 6, No 1 (2009)

Factor VII Recombinante Activado para el Tratamiento de la Hemorragia de Difícil Control en UCI, Una Serie de Casos

Pablo Pérez d’Empaire, Stevens Salva Sutherland, Juan Pal Otero, Fernando Pérez Barreto, Gabriel d’Empaire Yánez

Resumen


Antecedentes. El Factor VII recombinante activado (Factor VIIa) ha sido utilizado para el tratamiento de pacientes hemofílicos con hemorragia, desde hace poco tiempo se ha extendido su uso para el control de hemorragia con coagulopatía establecida, en pacientes no hemofílicos en los cuales han fallado los tratamientos convencionales con hemoderivados. A continuación presentamos nuestra experiencia para el control de la hemorragia con Factor VIIa, en una serie de casos. Objetivo. Nuestro objetivo primario fue evaluar la detención del sangrado en pacientes no hemofílicos con hemorragia y coagulopatía, en los treinta minutos posteriores a la administración del Factor VIIa. Los objetivos secundarios fueron determinar la necesidad de administrar dosis adicionales de Factor VIIa y la evolución de los pacientes durante la primera semana. Método. Se estudiaron en forma retrospectiva los pacientes no hemofílicos que recibieron Factor VIIa para el control de la hemorragia, durante el período comprendido entre Enero del 2006 y Enero del 2008 en la Unidad de Cuidados Intensivos del Hospital de Clínicas Caracas. Resultados. Diez y ocho pacientes recibieron Factor VIIa para el control de la hemorragia. De estos diez y ocho, quince fueron hemorragias de causas postoperatorias, y tres fueron hemorragias digestivas. Los diez y ocho pacientes tenían serias alteraciones de las pruebas de coagulación y recibieron cantidades apropiadas de hemoderivados previo a la administración del Factor VIIa. Se determinó detención de la hemorragia en 14 (77,77%) de los casos en los primeros treinta minutos posteriores a la administración. Así mismo, se observó que para la detención de la hemorragia fue necesaria una segunda dosis en 6 (33,33%) de los casos en los primeros 30 minutos. Durante la primera semana fallecieron cuatro pacientes a los que no se les detuvo la hemorragia, y de los catorce a quienes se les detuvo tres fallecieron durante la primera semana debido a causas diferentes a la hemorragia. Conclusiones. La administración del Factor VIIa para el control de la hemorragia masiva en pacientes no hemofílicos con trastornos de coagulación, refractarios al tratamiento con hemoderivados, resultó ser efectiva para corregir la hemorragia masiva. Hasta el momento, esta es la mayor serie reportada en nuestro país. Sin embargo, son necesarios estudios más grandes, controlados y aleatorizados para establecer el efecto de este tratamiento sobre la mortalidad. Palabras clave: Factor VII recombinante activado; hemorragia masiva; hemostasia; coagulopatía.

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Activated Recombinant Factor VII for the Treatment of the Hemorrhage of Difficult Control in ICU, a Series of Cases


ABSTRACT


Background. The Activated Recombinant Factor VII (rFVIIa) has been used for the treatment of hemorrhage in patients with hemophilia. Recently, the use of rFVIIa has been extended for the hemorrhage control when the coagulopathy is established in patients who are not hemophilic, when the conventional treatment has failed. As it follows we present our experience about hemorrhage control with rFVIIa in a case serie. Objective. Our primary objective was to evaluate the control of bleeding in non hemophilic patients with hemorrhage and coagulopathy within thirty minutes after the rFVIIa administration. Our second objectives were to determine the need to give additional doses and the patient outcome during the first week. Method. We did a retrospective study about all the non hemophilic patients who received rFVIIa for hemorrhage control, in Hospital de Clínicas Caracas Intensive Care Unit from 2006 January to 2008 January. Results. Eighteen patients received rFVIIa for hemorrhage control, fifthteen had postoperative hemorrhage, and three had gastrointestinal bleeding, all the eighteen patients had severe alterations in their coagulation function tests and they all received blood products before the rFVIIa administration. It was determinated that the bleeding was stopped in 14 (77.77%) patients within the first 30 minutes after the rFVIIa administration. Also it was determinated that a second dose was needed for the hemorrhage control in 6 (33.33%) patients within the first 30 minutes. During the first week, four patients in whom their hemorrhage did not stop died, and from the fourthteen patients whom their bleeding was stopped, three died from non hemorrhagic causes. Conclusion. The rFVIIa administration was effective for the hemorrhage control in non hemophilic patients with coagulation alterations in whom the hemorrhage did not stop with the blood products administration. This is the largest case series reported in our country so far. However larger and randomized studies are needed to establish an effect of this treatment in mortality.

Key words: Activated recombinant factor VII; massive hemorrhage; hemostasia; coagulopathy.

Citas


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