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FVIIa corrects the coagulopathy of fulminant hepatic failure but may be associated with thrombosis: a report of four cases

[Le FVIIa corrige la coagulopathie d’une insuffisance hépatique fulminante, mais peut être associé à la thrombose : présentation de quatre cas]

Patricia Pavese, MD^*, Agnès Bonadona, MD^*, Jean Beaubien, MD, Pascal Labrecque, MD, Gilles Pernod, MD, Christian Letoublon, MD and Didier Barnoud, MD^*

^* From the Departments of Réanimation Médicale, CHU de Grenoble, Grenoble, France;
Anesthésie-Réanimation, CHU de Québec, Québec, Canada;
Hématologie, and
Chirurgie Digestive, CHU de Grenoble, Grenoble, France.

Address correspondence to: Dr. Patricia Pavese, Réanimation Médicale, Département de Médecine Aigue Spécialisée, CHU de Grenoble, Hôpital Michalon, 38043, Grenoble Cedex 9, France. Phone: 04-76-76-55-05; Fax: 04-76-76-51-87; E-mail: PPavese{at}chu-grenoble.fr

Purpose: During liver transplantation, excessive blood losses are correlated with increased morbidity and mortality. Blood losses are particularly high in the case of urgent liver transplantation for fulminant hepatic failure (FHF). Recombinant activated factor VII (rFVIIa) has shown promise in treating the coagulopathy of liver disease. We review our experience with the use of rFVIIa in treating the coagulopathy of FHF during urgent liver transplantation.

Clinical features: We report four patients with FHF who met King’s College criteria for liver transplantation and in whom rFVIIa was used after conventional means for treating the associated coagulopathy had failed. In all patients, the coagulation defect was corrected by rFVIIa. However, thrombotic complications occurred in two patients (myocardial ischemia and portal vein thrombosis) and the implication of rFVIIa cannot be excluded.

Conclusion: We conclude that rFVIIa is effective in the correction of the coagulopathy associated with FHF. However, thrombotic events are of concern and therefore, further studies are warranted to define the safety of rFVIIa in that setting.

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