Srpski arhiv za celokupno lekarstvo 2008 Volume 136, Issue Suppl. 3, Pages: 240-245
https://doi.org/10.2298/SARH08S3240V
Full text ( 247 KB)
The use of recombinant activated factor VII in the treatment of gastrointestinal bleeding following acetylsalicylic acid therapy in a surgical patient
Vučelić Dragica (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 (Clinical Centre of Serbia, Institute for Digestive System Diseases, Belgrade)
Bjelović Miloš (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)