[The use of recombinant coagulation factor VIIa in patients undergoing surgical correction of scoliosis with the C-D method]

Abstract

Background. Excessive intraoperative bleeding during scoliosis correction extends surgery time, and may increase the risk of complications during surgery and the postoperative period. Recombinant factor VIIa (rVIIa) is widely used to control hemorrhage in patients with hemophilia. Recent reports have examined the use of rVIIa for intraoperative bleeding in patients without coagulopathies. The aim of our study was to evaluate the influence of rVIIa on selected coagulation parameters and blood loss in patients undergoing surgical correction of scoliosis. Material and methods. 62 patients undergoing surgical correction of scoliosis were included in the study. The treatment group consisted of 29 patients who received rVIIa (20 g/kg). The coagulation parameters were evaluated at 15 minutes, 2 hours, 4 hours and 12 hours after the start of surgery. The control group consisted of 33 patients who underwent the same surgery without pharmacological blood loss control. Results. A single administration of rVIIa resulted in a reduction of prothrombin (PT) time and APTT. The effect was observed until the 4th hour of surgery, after which time the value of coagulation parameters increased and reached preoperative values after 12 hours. The volume of blood loss in the treatment group was 1046 ml, compared to 1393 ml in the control group. Conclusions. The use of small doses of rVIIa in healthy patients resulted in rapid thrombin activation at places of tissue damage caused by surgery. During extensive scoliosis surgery, the effect of rVIIa on coagulation process led to a reduction of the time spent in surgery.