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Aortic dissection and hypothermic arrest in a Jehovah’s Witness patient: a case for recombinant factor VIIa?

[Dissection aortique et asystolie sous hypothermie chez un Témoin de Jéhovah : un cas pour le facteur VIIa recombinant ?]

From the Department of Anesthesia, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada.

Address correspondence to: Dr. Brian Muirhead, GH611, Department of Anesthesia, General Health Sciences Centre, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada. Phone: 204-787-4816; E-mail: bmuirhead{at}hsc.mb.ca

Purpose: To present a case of survival of a cognitively intact Jehovah’s Witness patient with an aortic dissection who underwent hypothermic arrest. Recombinant factor VIIa, but no blood products were administered.

Clinical features: An 83-yr-old female with an acute type A aortic dissection underwent emergent surgical repair. Proximal extension of the dissection necessitated prolonged cardiopulmonary bypass (CPB) and hypothermic circulatory arrest. Despite this, perioperative hemostatis was adequate. Recombinant factor VIIa 90 µg·kg^–1 iv was administered post-CPB. The patient had an uneventful postoperative course, and was discharged home neurologically intact.

Conclusions: Patients who conscientiously object to the transfusion of blood products may present a considerable anesthetic challenge, especially those at risk from coagulopathy associated with CPB and hypothermic circulatory arrest. Recombinant factor VIIa may play a role in hemostasis management of these individuals, however, well-designed randomized controlled trials need to be undertaken to establish the efficacy and risks related to this potential indication.

Related articles in CJA:

Preemptive use of recombinant activated factor VII: many questions but few answers/L’usage préventif du facteur VII recombinant activé : beaucoup de questions, peu de réponses

Charles Marc Samama
CJA 2006 53: 336-338. [Full Text]  

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				C. M. Samama Preemptive use of recombinant activated factor VII: many questions but few answers/L'usage preventif du facteur VII recombinant active : beaucoup de questions, peu de reponses. Can J Anesth, April 1, 2006; 53(4): 336 - 338. [Full Text] [PDF]