FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2138828265> ?p ?o ?g. }

• W2138828265 endingPage "558" @default.
• W2138828265 startingPage "558" @default.
• W2138828265 abstract "Editor—We read with interest the article by Ahonen and colleagues.1Ahonen J Jokela R Recombinant factor VIIa for life-threatening post-partum haemorrhage.Br J Anaesth. 2005; 94: 592-595Crossref PubMed Scopus (139) Google Scholar All patients in the case series sustained severe post-partum haemorrhage (PPH) and transfusion requirements were high. However, it is difficult to make assessments of the efficacy of recombinant factor VIIa (rFVIIa) from the data presented. As stated in the accompanying editorial,2Spahn DR Tucci MA Makris M Editorial: Is recombinant FVIIa the magic bullet in the treatment of major bleeding?.Br J Anaesth. 2005; 94: 553-555Crossref PubMed Scopus (27) Google Scholar we need randomized controlled trials to determine whether rFVIIa is effective, but these studies are unlikely to be implemented in the setting of unanticipated PPH. However, the authors do have data available that could help demonstrate the efficacy of rFVIIa. In the 3 yr before the 16 month study period, there were 29 hysterectomies performed in the setting of PPH. The authors could compare the outcomes (transfusions, estimated blood loss, ICU length of stay, hospital length of stay) of those 29 cases with the five patients who required hysterectomies performed in the 16 month period when rFVIIa was available. A more extensive comparison could include all PPHs with blood losses >5 litres. Although this type of study is affected more by bias than a randomized controlled trial, there is an advantage to studying a case series before and after a change in practice. In this type of study, measured outcomes are from normal clinical care that is uninfluenced by study protocols. In addition to studying the efficacy of rFVIIa, it would be worthwhile examining the cost effectiveness of this drug. This is a very expensive drug (a 4.8 mg vial currently costs ∼$7100 in the USA). However, if rFVIIa can be shown to reduce the number of blood transfusions required and other therapeutic interventions, then its cost would be easier to justify. When the cases from the report by Ahonen and colleagues are included with the others reported in the literature, rFVIIa has been used in 33 cases of severe obstetric haemorrhage, and post-partum haemorrhage was described in the majority. Proper dosing is difficult to determine because of the wide range of doses reported (mean total dose 149.6 µg kg−1). Most case reports describing the use of rFVIIa for postoperative haemorrhage have shown a haemostatic effect with doses of 60–120 µg kg−1 after a maximum of two doses. We recommend starting with a dose of 60 µg kg−1 and, if necessary, escalating the dose until an adequate haemostatic effect is obtained. Exactly what type of case will rFVIIa be useful in? There is not a clear pattern in the literature, but cases of bleeding refractory to standard therapy with blood replacement products and surgical management would be most appropriate. We emphasize that in situations of severe unanticipated PPH, surgical tamponade (using uterine packs, B lynch brace suture, hydrostatic balloon catheters), correction of anaemia and abnormal coagulation (with red blood cells, fresh frozen plasma, platelets and cryoprecipitate), treatment of hypothermia and acidosis, invasive corrective measures (uterine artery embolization, uterine artery ligation) and the administration of pharmacological agents (uterotonics) are still the most important management strategies. However, it is possible that rFVIIa may reduce the number of hysterectomies performed in situations of severe obstetric haemorrhage refractory to other therapeutic interventions. Editor—We appreciate the comments of Drs Butwick and Riley on our case report about the use of rFVIIa in life-threatening PPH.1Ahonen J Jokela R Recombinant factor VIIa for life-threatening post-partum haemorrhage.Br J Anaesth. 2005; 94: 592-595Crossref PubMed Scopus (139) Google Scholar During a 3 yr period, 29 women underwent hysterectomy at our institution because of life-threatening PPH. The 5 patients presented in our case series1Ahonen J Jokela R Recombinant factor VIIa for life-threatening post-partum haemorrhage.Br J Anaesth. 2005; 94: 592-595Crossref PubMed Scopus (139) Google Scholar are included in this number. An additional 6 parturients underwent hysterectomy during the time period when rFVIIa was available but did not receive this medication because at that time we did not have guidelines for the use of rFVIIa. In 2003, we started to use rFVIIa in life-threatening PPH. With growing experience we started to use it to avoid hysterectomy. We believe that the patient series of 29 women undergoing a hysterectomy is biased that would be of no benefit in drawing any conclusions about the efficacy of rFVIIa. We agree that rFVIIa is an expensive drug. At our institution, the cost of a mean single dose of rFVIIa is similar to that of an ICU treatment for 2 days. Only 3 of our 12 patients required ICU treatment, each for 1–2 days. Apart from one patient who was hospitalized for 5 weeks owing to an intra-abdominal infection, all other patients were discharged home in <14 days (mean 7 days).1Ahonen J Jokela R Recombinant factor VIIa for life-threatening post-partum haemorrhage.Br J Anaesth. 2005; 94: 592-595Crossref PubMed Scopus (139) Google Scholar We therefore believe that in major uncontrolled bleeding, the use of rFVIIa may turn out to be cost-effective in avoiding massive transfusions of blood products and complications requiring ICU treatment. We nowadays use a dose of 90–120 µg kg−1 of rFVIIa.3Martinowitz U Kenet G Segal E et al.Recombinant activated factor VII for adjunctive hemorrhage control in trauma.J Trauma. 2001; 51: 431-439Crossref PubMed Scopus (427) Google Scholar4Veldman A Hoffman M Ehrenforth S A new insight into the coagulation system and implications for new therapeutic options with recombinant factor VIIa.Curr Med Chem. 2003; 10: 797-811Crossref PubMed Scopus (70) Google Scholar The effective dose of rFVIIa in the treatment of major PPH may depend on its mechanism of action, which remains to be established. We agree that surgery and/or medical management with effective transfusion therapy and uterotonic drugs is the cornerstone of the treatment of major PPH. However, the choice between additional interventions such as selective arterial embolization or the use of rFVIIa is not straightforward, and we strongly believe that all these manoeuvres should be available. J. Ahonen* R. Jokela Helsinki, Finland *E-mail: [email protected]" @default.
• W2138828265 created "2016-06-24" @default.
• W2138828265 creator A5010001337 @default.
• W2138828265 creator A5039947544 @default.
• W2138828265 date "2005-10-01" @default.
• W2138828265 modified "2023-10-03" @default.
• W2138828265 title "Recombinant factor VIIa for life-threatening post-partum haemorrhage" @default.
• W2138828265 cites W1909740408 @default.
• W2138828265 cites W1964254620 @default.
• W2138828265 cites W1975210832 @default.
• W2138828265 cites W2002836977 @default.
• W2138828265 cites W202945586 @default.
• W2138828265 cites W2032561566 @default.
• W2138828265 cites W2039103151 @default.
• W2138828265 cites W2045000983 @default.
• W2138828265 cites W2069798347 @default.
• W2138828265 cites W2108118717 @default.
• W2138828265 cites W2120949451 @default.
• W2138828265 cites W2144537409 @default.
• W2138828265 cites W2151068270 @default.
• W2138828265 cites W2153133812 @default.
• W2138828265 cites W2158656134 @default.
• W2138828265 cites W2168770614 @default.
• W2138828265 cites W2170353634 @default.
• W2138828265 cites W3138909697 @default.
• W2138828265 cites W66148929 @default.
• W2138828265 cites W69280588 @default.
• W2138828265 cites W99696493 @default.
• W2138828265 doi "https://doi.org/10.1093/bja/aei594" @default.
• W2138828265 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/16155040" @default.
• W2138828265 hasPublicationYear "2005" @default.
• W2138828265 type Work @default.
• W2138828265 sameAs 2138828265 @default.
• W2138828265 citedByCount "64" @default.
• W2138828265 countsByYear W21388282652012 @default.
• W2138828265 countsByYear W21388282652013 @default.
• W2138828265 countsByYear W21388282652014 @default.
• W2138828265 countsByYear W21388282652015 @default.
• W2138828265 countsByYear W21388282652016 @default.
• W2138828265 countsByYear W21388282652017 @default.
• W2138828265 countsByYear W21388282652020 @default.
• W2138828265 crossrefType "journal-article" @default.
• W2138828265 hasAuthorship W2138828265A5010001337 @default.
• W2138828265 hasAuthorship W2138828265A5039947544 @default.
• W2138828265 hasBestOaLocation W21388282651 @default.
• W2138828265 hasConcept C126322002 @default.
• W2138828265 hasConcept C141071460 @default.
• W2138828265 hasConcept C186738567 @default.
• W2138828265 hasConcept C2776035437 @default.
• W2138828265 hasConcept C2778382381 @default.
• W2138828265 hasConcept C2778961111 @default.
• W2138828265 hasConcept C2779234561 @default.
• W2138828265 hasConcept C2779494336 @default.
• W2138828265 hasConcept C2779936836 @default.
• W2138828265 hasConcept C2780930249 @default.
• W2138828265 hasConcept C2908626413 @default.
• W2138828265 hasConcept C2911105935 @default.
• W2138828265 hasConcept C3017863008 @default.
• W2138828265 hasConcept C3018065600 @default.
• W2138828265 hasConcept C42219234 @default.
• W2138828265 hasConcept C54355233 @default.
• W2138828265 hasConcept C545542383 @default.
• W2138828265 hasConcept C71924100 @default.
• W2138828265 hasConcept C86803240 @default.
• W2138828265 hasConceptScore W2138828265C126322002 @default.
• W2138828265 hasConceptScore W2138828265C141071460 @default.
• W2138828265 hasConceptScore W2138828265C186738567 @default.
• W2138828265 hasConceptScore W2138828265C2776035437 @default.
• W2138828265 hasConceptScore W2138828265C2778382381 @default.
• W2138828265 hasConceptScore W2138828265C2778961111 @default.
• W2138828265 hasConceptScore W2138828265C2779234561 @default.
• W2138828265 hasConceptScore W2138828265C2779494336 @default.
• W2138828265 hasConceptScore W2138828265C2779936836 @default.
• W2138828265 hasConceptScore W2138828265C2780930249 @default.
• W2138828265 hasConceptScore W2138828265C2908626413 @default.
• W2138828265 hasConceptScore W2138828265C2911105935 @default.
• W2138828265 hasConceptScore W2138828265C3017863008 @default.
• W2138828265 hasConceptScore W2138828265C3018065600 @default.
• W2138828265 hasConceptScore W2138828265C42219234 @default.
• W2138828265 hasConceptScore W2138828265C54355233 @default.
• W2138828265 hasConceptScore W2138828265C545542383 @default.
• W2138828265 hasConceptScore W2138828265C71924100 @default.
• W2138828265 hasConceptScore W2138828265C86803240 @default.
• W2138828265 hasIssue "4" @default.
• W2138828265 hasLocation W21388282651 @default.
• W2138828265 hasLocation W21388282652 @default.
• W2138828265 hasOpenAccess W2138828265 @default.
• W2138828265 hasPrimaryLocation W21388282651 @default.
• W2138828265 hasRelatedWork W1966686849 @default.
• W2138828265 hasRelatedWork W1976131017 @default.
• W2138828265 hasRelatedWork W1992231251 @default.
• W2138828265 hasRelatedWork W2138828265 @default.
• W2138828265 hasRelatedWork W2156235242 @default.
• W2138828265 hasRelatedWork W2170353634 @default.
• W2138828265 hasRelatedWork W2401864709 @default.
• W2138828265 hasRelatedWork W2978914497 @default.
• W2138828265 hasRelatedWork W3138909697 @default.
• W2138828265 hasRelatedWork W2514058493 @default.

• next