Recombinant Factor VIIa in Massive Bleeding at Hospital Universiti Sains Malaysia: A Retrospective Case Control Analysis

Introduction: Massive bleeding carries major clinical challenge as it needs to be managed in a limited timeframe. Vigorous fluid resuscitation and massive transfusion has benefit to risk profile in terms of patientsurvival. This study aims to look at the indications and outcomes of non-haemophilia patients treated withand without rFVIIa during massive bleeding in Hospital Universiti Sains Malaysia (HUSM).Methods: We conducted a retrospective case control analysis in Hospital Universiti Sains MalaysiaKubangKerian, Kelantan from the year 2013 to 2016. 140 patients who fulfilled the inclusion and exclusioncriteria were selected as the case and control group and were analysed. They were matched according to thecauses of the massive bleeding.Result: There were about 30 (42.9%) medical patients and 40 (57.1%) surgical patients who receivedrFVIIa. SOFA score of case group showed a higher mean score then the control group (p = 0.038) and wasassociated with overall survival of the case group (p<0.001). Further analysis noted that the surgical patientsin the case group have better survival with lower SOFA Score (p=0.001). There was significant reduction inall the blood and blood product after initial dose of rFVIIa. No significant differences in thromboembolicevent noted.Conclusion: This study indicates the benefits of intervention with rFVIIa for management of massivebleeding in surgical patients with lower SOFA Score. A reduced in the amount of transfusion requirementobserved with rFVIIa usage hence reducing the possible adverse effect of massive transfusion. There was no significant difference in thromboembolic complication between the groups hence safety profile of rFVIIawere proven.