Abstract
INTRODUCTION: Further development of extensive spinal surgical techniques forced surgeons to find drugs helpful in reducing blood lose during surgery. These drugs are necessary in surgical treatment in patients with congenital or acquired bleeding disorders. Recombinant FVIIa appears to be an efficient haemostatic product for surgery in patients suffering from bleeding disorder. Recombinant activated factor VII (rFVIIa) has recently been introduced for improving haemostasis in non-haemophiliac patients during extensive surgical procedures.
AIM: The present study evaluates the use of low dose of recombinant factor VIIa during scoliosis surgery and its influence on blood coagulation tests and haemostasis.
MATERIAL AND METHODS: 22 patients from evaluated group were treated with Cotrell-Dubosset distraction method with posterior spondylodesis and gibectomy during the same surgical procedure with bone grafts taken from patients iliac crest received a single 10 micrograms/kg dose of recombinant FVIIa given as a i.v. bolus.
Control group consists of 30 patients treated with use of identical surgical technique but without any factors influencing blood coagulation. Fibrinogen value, prothrombine time, APTT and INR value altogether with thrombocytes count were measured day before operation and 15 minutes, two, four and 12 hours after administration of rFVII.
RESULTS: Authors report effective haemorrhage control, decrease in prothrombine time and INR value, reduced thrombocytes count and stabile patients haemodynamics parameters. Changes in these parameters occurred 15 minutes after intravenous administration of recombinant VIIa factor, remained unchanged up to four hours after dosage and its normalisation were observed 12 hours after single intravenous bolus of 10 micrograms/kg of body mass. APTT and fibrinogen value remained unchanged.
CONCLUSION: Authors conclude that use of small doses of recombinant VIIa factor causes short and fast thrombin activation by relived tissue factor (TF), what effectively reduces bone ant tissue bleeding during extensive surgical procedures.
The use of recombinant VIIa factor shortens operation time and reduces number of blood transfusions.
These abstracts were prepared by Dr Robert J. Moore. Correspondence should be addressed to him at Spine Society of Australia, Institute of Medical and Veterinary Science, The Adelaide Centre for Spinal Research, Frome Road, Adelaide, South Australia 5000.
