• Lauren Sutherland, Abigail Houchin, Tian Wang, Shuang Wang, Vivek Moitra, Akshit Sharma, Trip Zorn, and Brigid C Flynn.
• Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY.
• J. Cardiothorac. Vasc. Anesth. 2022 Jan 1; 36 (1): 147-154.

ObjectiveRecombinant factor VII (rFVIIa) is used to treat cardiac surgical bleeding in an off-label manner. However, optimal dosing and timing of administration to provide efficacious yet safe outcomes remain unknown.DesignRetrospective, observational study.SettingTertiary care academic center.ParticipantsCardiac surgical patients (N = 214) who received low-dose rFVIIa for cardiac surgical bleeding.InterventionsPatients were allocated into one of three groups based on timing of rFVIIa administration during the course of bleeding resuscitation based on the number of hemostatic products given before rFVIIa administration: group one = ≤one products (n = 82); group two = two-to-four products (n = 73); and group three= ≥five products (n = 59).Measurements And Main ResultsPatients who received low-dose rFVIIa later in the course of bleeding resuscitation (group three) had longer intensive care unit stays (p = 0.014) and increased incidence of postoperative renal failure when compared with group one (p = 0.039). Total transfusions were lowest in patients who received rFVIIa early in the course of resuscitation (group one) (median, two [interquartile range (IQR), 1-4.75]) and highest in group three (median, 11 [IQR, 8-14]; p < 0.001). Subsequent blood product transfusions after rFVIIa administration were highest in group two (p = 0.003); however, the median for all three groups was two products. There were no differences in thrombosis, reexplorations, or mortality in any of the groups.ConclusionsThis study identified no differences in adverse outcomes based on timing of administration of low-dose rFVIIa for cardiac surgical bleeding defined by stage of resuscitation, but the benefits of early administration remain unclear.Copyright © 2021 Elsevier Inc. All rights reserved.

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