Recombinant Activated Factor VII (rFVIIa) for Bleeding After Thoracic Aortic Surgery: A Scoping Review of Current Literature

Bleeding after surgery on the thoracic aorta is a frequent complication and can be associated with a significant increase in morbidity and mortality. Recombinant activated factor VII (rFVIIa) was initially developed for treating hemophilia patients; however, it has been increasingly used “off-label” to achieve hemostasis after thoracic aortic procedures. This scoping review aimed to present the available literature on the role of rFVIIa in management of refractory postoperative bleeding after thoracic aortic surgery. An electronic database search was conducted using Medline, Embase, Cochrane Library, and Google Scholar in June 2023. We included studies that reported the use of rFVIIa in patients undergoing surgical repair of ascending or descending aortic aneurysm or dissection. Single-case reports were excluded. Ten publications with a pooled number of 649 patients (319 patients received rFVIIa and 330 in the control groups) were identified: three case series, six retrospective studies, and one non-randomized clinical trial. All studies reported the potential role of rFVIIa in correcting coagulopathy and reducing postoperative blood loss in this group of patients. Overall, there was not enough evidence to suggest that rFVIIa was associated with higher rates of thromboembolic complications or mortality. Limited evidence suggests that rFVIIa may be useful in managing postoperative refractory bleeding in patients undergoing thoracic aortic surgery. However, the impact of rFVIIa on thromboembolic complications and mortality rates remains unclear. This is special type of abstract that is so short and could be inserted after main abstract of article, as a blurb or inserted as annotations into a Table of contents [Display omitted]