Factor VIIa has been used to more rapidly reverse coumadin anticoagulation than FFP
In addition, since the INR does not fully reflect the mechanism of action of factor VII in vivo, Factor VIIa may provide benefit over simply correcting the INR with FFP
Glanzmann’s Thrombasthenia (see Glanzmann’s Thrombasthenia, [[Glanzmanns Thrombasthenia]]): has been used to treat patients with platelet refractoriness
Hemorrhagic Complications of Stem Cell Transplantation (see Bone Marrow Transplant, [[Bone Marrow Transplant]])
Von Willebrand Disease (see Von Willebrand Disease, [[Von Willebrand Disease]]): in type 1, 2a, and 3 with antibodies against vWF
Pharmacology
Recombinant Factor VIIa
In Hemophilias: platelet-bound Factor VIIa partially restores platelet surface factor X activation
In Non-Hemophiliac Conditions: platelet-bound Factor VIIa increases activation of both factor IX and factor X and increases thrombin generation above normal levels -> increased thrombin enhances platelet activation and accumulation (including dysfunctional platelets)
Administration
IV
End-Stage Liver Disease: doses reported range from 5-120 ug/kg
Half-Life of Recombinant Factor VIIa: 2 hrs
Note: the half-life of normal factor VIIa is 4-6 hrs
Cost for Single 90 ug/kg IV Dose (US): $4500
Adverse Effects
Hematologic Adverse Effects
General Comments
Overall Rate of Events (most with off-label use): ranges from 1%-9.8%
Product packaging indicates that the rate of thrombotic events is 4% in patients with acquired hemophiia
Product packaging indicates that the rate of thrombotic events is 0.2% of bleeding episodes in patients with congenital hemophiia
Recombinant factor VIIa for the prevention and treatment of bleeding in patients without haemophilia. Cochrane Database Syst Rev. 2012 Mar 14;3:CD005011. doi: 10.1002/14651858.CD005011.pub4 [MEDLINE]