Recombinant human coagulation factor VIIa(Chengdu Rongsheng)

Objective: Exploring the management of perioperative coagulation function in patients with end-stage heart failure undergoing left ventricular assist device implantation surgery. Methods: Collect clinical data of four end-stage heart failure cases who underwent left ventricular assist device implantation surgery at TEDA International Cardiovascular Hospital from September to November 2023, including surgical conditions, coagulation indicators, application of blood products and coagulation drugs, and conduct literature review. Results: Four patients underwent left ventricular assist device implantation surgery, as well as tricuspid valve shaping and left atrial appendage closure surgery. One patient underwent mitral valve shaping surgery, while the other underwent aortic valve replacement surgery. All patients used blood products such as platelets and cryoprecipitate during the surgery. They also used clotting drugs such as fibrinogen and recombinant human coagulation factor VIIa during surgery. After returning to the intensive care unit, all patients received oral warfarin and heparin bridged anticoagulant therapy. All patients did not experience any coagulation related complications and were discharged smoothly. Currently, all patients have a good quality of life. Conclusions: The coagulation management of left ventricular assist device implantation surgery for end-stage heart failure is influenced by multiple factors such as etiology and surgical impact, and The management strategy presented in this paper can serve as a reference method for reducing coagulation-related complications in clinical practice.

Acquired factor VIII inhibitor, also known as acquired haemophilia A, has been associated with the postpartum state in young females. Treatment of acquired haemophilia A is focused on two goals: control of bleeding and eliminating the factor VIII inhibitor. Management requires successful intervention to accomplish both goals. Here, we describe the presentation and management of a case of acquired haemophilia A resulting in particularly severe and protracted intra-abdominal bleeding after routine laparoscopic cholecystectomy in a young and otherwise healthy female at 3 months postpartum. Due to diffuse intra-abdominal bleeding, she required return to the operating room on five occasions for intra-abdominal packing, reassessment of bleeding and ultimate fascial closure. Her abdomen was open for 5 days. She was treated with activated recombinant human factor VIIa to bypass inhibited factor VIII, and with immunosuppression using steroids, cyclophosphamide and anti-CD20 monoclonal antibody rituximab. She achieved remission after 6 weeks of treatment.