Case report

Failure of recombinant factor VIIa in a patient with severe polymicrobial sepsis and postoperative uncontrolled intraabdominal bleeding

Anna Conen¹ , Maja Weisser^1,2 , Dimitrios A Tsakiris³ and Martin Siegemund^2,4

¹  Department of Infectious Diseases, University Hospital, Basel, Switzerland

²  Medical Intensive Care Unit, University Hospital, Basel, Switzerland

³  Division of Haematology, University Hospital, Basel, Switzerland

⁴  Department of Anaesthesia and Intensive Care Medicine, University Hospital, Basel, Switzerland

author email corresponding author email

BMC Infectious Diseases 2007, 7:34doi:10.1186/1471-2334-7-34

Published:	26 April 2007

Abstract

Background

This report discusses a case of unsuccessful treatment with recombinant factor VIIa (rFVIIa) in off-label use. The need for international guidelines concerning the off-label use of rFVIIa is outlined as well as the need for methods to control the efficacy of rFVIIa objectively.

Case presentation

54 year old male with severe polymicrobial sepsis due to a perforated diverticulitis of the sigmoid colon and consecutive overt disseminated intravascular coagulation. He suffered severe intraabdominal bleeding after abdominal surgery despite conventional haemostatic support. Repeated applications of factor VIIa temporarily improved coagulation essays but did not stop clinical bleeding. The patient died in multiorgan failure due to septic and haemorrhagic shock.

Conclusion

Off-label use of rFVIIa could result in more side effects than could be expected from literature because of a publication bias. However for most off-label applications large prospective, randomised and controlled trials to confirm the positive findings are missing. For the future, not only guidelines concerning the off-label use of rFVIIa are urgently needed but also guidelines for monitoring the efficacy of rFVIIa.