The use of recombinant activated factor VII in a patient with uncontrolled bleeding from the gastrointestinal tract

摘要

NTRODUCTION. Massive intestinal bleeding is a life threatening clinical condition that requires prompt reaction. Recombinant activated factor VII (rFVIIa) is a novel and promising therapeutic approach. The administration of rFVIIa usually represents the last therapy resort, when all other alternatives are exhausted. CASE OUTLINE. We present a 55-year old female patient admitted to our hospital due to intestinal bleeding of unknown origin, with anamnestic and heteroanamnestic data, clinical condition that was the consequence of massive bleeding, diagnostic and therapeutic procedures. After diagnostic procedures, the conventional medicamentous therapy was commenced. On the 6th day of therapy, surgery was performed with the aim to identify the source of bleeding. After the confirmation that the bleeding was not due to surgical reasons, we administrated rFVIIa in a bolus dose of 90 mcg/kg, which resulted in the prompt arrest of bleeding. Side effects of the drug were not registered. CONCLUSION. In our patient, the administration of rFVIIa resulted in a prompt and efficient haemostasis, which was not followed by the recurrence of bleeding. Preconditions necessary for rFVIIa administration are the adequate substitution of blood products, exclusion of surgical cause of bleeding, as well as the levels of fibrinogen, platelets and pH equal or above recommended.