Effect evaluation of blood component transfusion combined with recombinant activated factor VIIa in treatment of severe active hemorrhage after cardiac surgery

Abstract

Objective To evaluate the efficacy and complications of component blood transfusion combined with recombinant activated factor Ⅶa(rFⅦa)in treatment of severe active hemorrhage after cardiac surgery. Methods Fifty patients who suffered from severe active hemorrhage after cardiac surgery were selected from the First Affiliated Hospital of Dalian Medical University from July 2015 to May 2017.All patients were divided into GR group(component blood transfusion combined with rFⅦa)and GA group(component blood transfusion combined with tranexamic acid)by random number table method, 25 cases in each group.The changes of disseminated intravascular coagulation (DIC) were screened on admission(D1), after cessation of cardiopulmonary bypass(D2), and 2 h (D3), 6 h (D4) and 12 h (D5) after medication.The difference of activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen, hemoglobin and platelet of the two groups at each time point of D1, D2, D3, D4 and D5 were analyzed.Meanwhile, the postoperative drainage, postoperative blood transfusion, postoperative plasma transfusion volume, postoperative mechanical ventilation time, ICU retention time, the 30 d mortality and complications were compared between the two groups. Results There were significant differences in APTT, INR, fibrinogen, hemoglobin and platelet between the two groups (all P 0.05), but at D3 time point, APTT in GR group was significantly shorter than that in GA group((50.3±6.6)s vs.(60.1±6.5)s, P=0.027), and INR in GR group at D4 time point was also significantly lower ((1.3±0.3)vs.(1.5±0.3), P=0.041). In addition, the amount of red blood cells transfusion after treatment in GR group and GA group ((3.2±1.0)U vs.(4.1±1.0)U, P=0.005), the amount of fresh plasma transfusion ((303.2±98.5) ml vs.(469.6±190.5) ml, P=0.000), the amount of 24 h drainage after operation ((519.9±107.5) ml vs.(657.2±100.1) ml, P=0.000)were significantly decreased, the differences were statistically significant. Conclusion Blood component transfusion combined with rFⅦa can significantly improve APTT and INR of severe active hemorrhage after cardiac surgery, at the same time, it can reduce the amount of red blood cells transfusion and plasma transfusion. Key words: Cardiac Surgical Procedures; Postoperative Hemorrhage; Recombinant activated factor Ⅶa; Blood transfusion; Cardiac disease