Wednesday December 17, 2008
Interesting case report - Acute Left Atrial Thrombus After rFactor VIIa Administration

Editors' note: As Factor 7 is getting more and more used in cinical practices, we think, this is an important case report to atleast have a look on. Our criticism on following case report is that - the amount of Factor 7 used was 'humongous'. Usually 1.2mg - 4.8 mg should be sufficient.


This is a case report of a patient with end-stage heart failure and heparin-induced thrombocytopenia Type II, who required cardiopulmonary bypass (CPB) during a repeat implantation of a left ventricular assist device for long-term circulatory support. Bivalirudin was selected for anticoagulation during CPB, with concomitant infusion of aprotinin, in an effort to ameliorate blood loss. Nonetheless, profuse bleeding after CPB required massive transfusion of packed red blood cells, multiple coagulation factors, and platelets. Because of persistent bleeding, a single dose of recombinant factor VIIa (rFVIIa, 7.2 mg) was administered as rescue therapy. Within minutes, a large left atrial thrombus was detected by transesophageal echocardiography. We believe this is the first documentation of acute left atrial thrombus formation immediately after a single dose of recombinant factor VIIa administration during a left ventricular assist device implantation.



Reference: click to get abstract

Acute Left Atrial Thrombus After Recombinant Factor VIIa Administration During Left Ventricular Assist Device Implantation in a Patient with Heparin-Induced Thrombocytopenia - Anesth Analg 2008; 106:404-408