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Srpski arhiv za celokupno lekarstvo 2008 Volume 136, Issue Suppl. 3, Pages: 240-245
https://doi.org/10.2298/SARH08S3240V
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The use of recombinant activated factor VII in the treatment of gastrointestinal bleeding following acetylsalicylic acid therapy in a surgical patient

Vučelić Dragica ORCID iD icon (Clinical Centre of Serbia, Institute for Digestive System Diseases, Belgrade)
Sabljak Predrag (Clinical Centre of Serbia, Institute for Digestive System Diseases, Belgrade)
Peško Predrag (Clinical Centre of Serbia, Institute for Digestive System Diseases, Belgrade)
Stojakov Dejan (Clinical Centre of Serbia, Institute for Digestive System Diseases, Belgrade)
Ebrahimi Keramatollah (Clinical Centre of Serbia, Institute for Digestive System Diseases, Belgrade)
Nenadić Brankica (Clinical Centre of Serbia, Institute for Digestive System Diseases, Belgrade)
Pejović Dragan (Clinical Centre of Serbia, Institute for Digestive System Diseases, Belgrade)
Veličković Dejan ORCID iD icon (Clinical Centre of Serbia, Institute for Digestive System Diseases, Belgrade)
Bjelović Miloš ORCID iD icon (Clinical Centre of Serbia, Institute for Digestive System Diseases, Belgrade)

INTRODUCTION. Gastrointestinal bleeding is the most important complication associated with acetylsalicylic acid therapy. Patients with preexisting haemostatic disorders are at the higher risk and may experience life-threatening hemorrhagic syndrome. Platelet transfusions and desmopressin administration commonly successfully arrest bleeding. However, in clinical situations with profound bleeding and haemorrhagic shock, these therapeutic approaches may fail. CASE OUTLINE. We report a 24-year old female patient with previously undetected acquired platelet dysfunction, who underwent reconstructive surgical intervention. On the 20th postoperative day, acetylsalicylic acid was introduced due to reactive thrombocytosis (platelet count 1480x109/L) with daily dose of 100 mg tablets. On the 12th day of the acetylsalicylic acid treatment, massive gastrointestinal bleeding with haemorrhagic shock suddenly occurred. Attempts to control massive haemorrhage by resuscitation, blood products and haemostatics (desmopressin, tranexamic acid) failed. Two bolus doses of recombinant activated factor VII (rFVIIa) (100 μg/kg and 60 μg/kg respectively) in 90 minutes interval were given. Bleeding was successfully controlled with no requirements for further haemoproducts and haemostatic remedies treatment. CONCLUSION. This case demonstrates that the use of rFVIIa may be a specific treatment option in patients suffering from severe gastrointestinal bleeding associated with acetylsalicylic acid treatment.

Keywords: acetylsalicylic acid, gastrointestinal bleeding, recombinant activated factor VII (rFVIIa)