Recombinant factor VIIa reduces bleeding risk in patients on platelet aggregation inhibitors immediately prior to renal transplantation--a retrospective analysis.

BACKGROUND: Transplant surgery often requires an effective preoperative treatment which allows to reduce the risk of bleeding caused by platelet aggregation inhibitors without major delay. The use of recombinant activated coagulation factor VIIa (rFVIIa) may be a future treatment option in such patients.

METHOD: Five patients with end-stage renal disease on treatment with platelet aggregation inhibitors (ASA, Plavix, Aggrenox), who were scheduled for renal transplantation and received a preoperative bolus of recombinant factor VIIa (rFVIIa, NovoSeven) in a dose of 3 kIU/kg (60 microg/kg), were retrospectively analyzed. Parameters of plasmatic coagulation as well as bleeding time were determined before as well as after the administration of rFVIIa.

RESULTS: The initial median bleeding time was 7.3 min (range 6.2-14.6); after administration of rFVIIa it fell to 2.8 min (range 1.8-3.2). All patients had a good intraoperative hemostasis. None of the patients developed a hematoma requiring surgical treatment. The graft of all patients was homogeneously and well perfused, with a sufficient postoperative diuresis.

CONCLUSION: The administration of rFVIIa prior to renal transplantation in patients on treatment with platelet aggregation inhibitors was effective and without major complications. Further studies should be performed in order to confirm our observations.