Protein Information

Name factor VIIa
Synonyms Coagulation factor VII; Coagulation factor VII precursor; Cogulation factor VII; Eptacog alfa; F7; FVII coagulation protein; Factor VII; Factor VII active site mutant immunoconjugate…

Compound Information

Name warfarin
CAS

Reference List

PubMed Abstract RScore(About this table)
18375137 Dunning J, Versteegh M, Fabbri A, Pavie A, Kolh P, Lockowandt U, Nashef SA: Guideline on antiplatelet and anticoagulation management in cardiac surgery. Eur J Cardiothorac Surg. 2008 Jul;34(1):73-92. Epub 2008 Mar 28.

We review the following topics: evidence for aspirin, clopidogrel and warfarin cessation prior to cardiac surgery; perioperative interventions to reduce bleeding including the use of aprotinin and tranexamic acid; the use of thromboelastography to guide blood product usage; protamine reversal of heparin; the use of factor VIIa to control severe bleeding; anticoagulation after mechanical, tissue valve replacement and mitral valve repair; the use of antiplatelets and clopidogrel after cardiac surgery to improve graft patency and reduce thromboembolic complications and thromboprophylaxis in the postoperative period.
81(1,1,1,1) Details
19104685 Kalainov DM, Valentino LA: Recombinant activated factor VII as a temporary reversal agent for warfarin anticoagulation: a cautionary report on an off-label application. Am J Orthop (Belle Mead NJ). 2008 Nov;37(11):572-4.
31(0,1,1,1) Details
20172985 Rowe AS, Turner RM: Coagulation factor VIIa (recombinant) for warfarin-induced intracranial hemorrhage. Am J Health Syst Pharm. 2010 Mar 1;67(5):361-5.

Despite limited labeled indications, factor VIIa (recombinant) has been used to reverse warfarin-induced anticoagulation in patients with active hemorrhage, partly due to the rapid effect of factor VIIa on the International Normalized Ratio and the ability to administer the drug quickly in acute settings.
22(0,0,3,7) Details
18617125 Ilyas C, Beyer GM, Dutton RP, Scalea TM, Hess JR: Recombinant factor VIIa for warfarin-associated intracranial bleeding. . J Clin Anesth. 2008 Jun;20(4):276-9.
12(0,0,2,2) Details
19354059 Testerman GM, Shilad S, George KJ: Rapid warfarin reversal with factor VIIa in an elderly trauma patient with retroperitoneal hematoma. Tenn Med. 2009 Mar;102(3):37-9.
7(0,0,1,2) Details
19074054 Rosovsky RP, Crowther MA: What is the evidence for the off-label use of recombinant factor VIIa (rFVIIa) in the acute reversal of warfarin? ASH evidence-based review 2008. Hematology Am Soc Hematol Educ Program. 2008:36-8.
6(0,0,1,1) Details
18656871 Stein DM, Dutton RP, Hess JR, Scalea TM: Low-dose recombinant factor VIIa for trauma patients with coagulopathy. . Injury. 2008 Sep;39(9):1054-61. Epub 2008 Jul 25.

The aetiology of the coagulopathy in the study population included; TBI (40%), warfarin use (22%), and cirrhosis (13%).
3(0,0,0,3) Details
19131807 Stein DM, Dutton RP, Kramer ME, Scalea TM: Reversal of coagulopathy in critically ill patients with traumatic brain injury: recombinant factor VIIa is more cost-effective than plasma. J Trauma. 2009 Jan;66(1):63-72; discussion 73-5.

Baseline characteristics between the two groups were similar except that Injury Severity Score and admission International normalized ratio were higher in the rFVIIa group and the rFVIIa group had a higher percentage of patients with head Abbreviated Injury Scale score of 5 injuries, patients who underwent neurosurgical procedures and patients with preinjury warfarin use.
2(0,0,0,2) Details
20306240 Nairn TK, Giulivi A, Neurath D, Tokessy M, Sia YT, Ruel M, Wilkes PR: Urgent replacement of a mechanical mitral prosthesis in an anticoagulated patient with Bombay red blood cell phenotype. Can J Anaesth. 2010 Mar 20.

After cardiopulmonary bypass, heparinization was corrected with protamine and followed by a second dose of prothrombin complex concentrate and recombinant activated factor VIIa.
We report a case of urgent repeat sternotomy for replacement of a mechanical mitral prosthesis in a patient with Bombay phenotype anticoagulated with warfarin, to emphasize the transfusion challenges in such patients.
2(0,0,0,2) Details
20077167 Grobler C, Callum J, McCluskey SA: Reversal of vitamin K antagonists prior to urgent surgery. Can J Anaesth. 2010 Jan 15.

PURPOSE: The purpose of this article is to review the effective options for the reversal of vitamin K antagonists (warfarin and it coumarin analogues) and to help identify the option best suited for the patient requiring urgent surgery.
PRINCIPAL FINDINGS: Vitamin K antagonists, the mainstay in long-term anticoagulation therapy, can be reversed with the administration of vitamin K, frozen plasma (FP), recombinant factor VIIa (rFVIIa), or the recently approved four-factor prothrombin complex concentrate (PCC), Octaplex (R).
1(0,0,0,1) Details
18722586 Safaoui MN, Aazami R, Hotz H, Wilson MT, Margulies DR: A promising new alternative for the rapid reversal of warfarin coagulopathy in traumatic intracranial hemorrhage. Am J Surg. 2009 Jun;197(6):785-90. Epub 2008 Aug 22.

Its use should be considered as an alternative treatment to fresh-frozen plasma and recombinant Factor VIIa.
1(0,0,0,1) Details
18681490 Mallarkey G, Brighton T, Thomson A, Kaye K, Seale P, Gazarian M: An evaluation of eptacog alfa in nonhaemophiliac conditions. Drugs. 2008;68(12):1665-89.

There are effective therapies that correct all warfarin-induced factor deficiencies; thus, off-label use of eptacog alfa for reversal of warfarin should only be considered in the context of ICH.
We have analysed the published literature on eptacog alfa (recombinant factor VIIa; rFVIIa) for nonhaemophiliac conditions with the aim of determining its current place in therapy.
1(0,0,0,1) Details
18606103 Gurol ME, Greenberg SM: Management of intracerebral hemorrhage. . Curr Atheroscler Rep. 2008 Aug;10(4):324-31.

Among these are accurate diagnosis of cerebral amyloid angiopathy (CAA) during life, recognition of the association between CAA and warfarin-related ICH, use of newer hemostatic treatments, and the combination of minimally invasive surgery with hematoma thrombolysis.
Over the past 2 years, two major randomized studies in ICH (comparing early surgery with best medical management and testing the utility of hemostatic treatment within 4 hours using recombinant factor VIIa) have yielded neutral results.
1(0,0,0,1) Details
20332192 Elliott J, Smith M: The Acute Management of Intracerebral Hemorrhage: A Clinical Review. Anesth Analg. 2010 Mar 23.


ICH is the most feared complication of warfarin anticoagulation, and the need to arrest intracranial bleeding outweighs all other considerations.
0(0,0,0,0) Details