Author/Editor		Zver, Samo; Andoljšek, Dušan
Title		Rekombinantni faktor VIIa - nova možnost obvladovanja neobvladljive krvavitve pri kirurških bolnikih, poškodovancih in drugih motnjah hemostaze
Translated title		Recombinant factor VIIa - new treatment option for control of intractable bleeding in surgical and trauma patients and in other haemostasis disorders
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 73, št. Suppl 1
Publication year		2004
Volume		str. I-115-21
Language		slo
Abstract		Background. Recombinant factor Vlla (rFVIla), which is currently registered only for the treatment of haemophilia A and B patients with inhibitors, is seen increasingly as a possible universal haemostatic agent in untractable bleedings. One possible mechanism for the efficacy rFVIla may be a consequence of it's from the tissue factor (TF) and from the level of disfunction in haemostatic system independant activity, which generates "thrombin burst" formation. It seems that rFVlla remains active only at the site of tissue injury/bleeding. Conclusions. There are two components of bleeding in surgery and trauma patients. One is bleeding from large calibre arteries and veins which requires surgical intervention. The other, which goes along with the first one, is coagulopathic bleeding. The latter is a consequence of consumptional and dilutional coagulopathy, hypothermia, multitransfusion syndrom and metabolic disbalances in patients. rFVlla effects coagulopathic component of the bleeding. For effective treatment with rFVIIa in such patients, replacement therapy with erythrocytes, platelets and fresh frozen plasma is mandatory and requires a haematologist assistance in the treatment strategy. Most reported cases of effective rFVlla usage are from the field of traumatology. Until now, there have been no universal recommendations when to start treatment with rFVlla in a bleeding trauma patient. Most experience with rFVlla are from Israel and their recommendations are perhaps the most valuable ones. rFVlla was used several times during intra-operative and post-operative bleeding episodes. There are reports of clinical studies and usage in patients with/after prostate surgery, cardiovascular operations and liver transplants. There are data about effective rFVlla usage in neurology and neurosurgery patients (intracranial haemorrhages), obstetrics and gynecology field. (Abstract truncated at 2000 characters).
Summary		Izhodišča. Rekombinantni faktor Vlla (rFVlla), ki je trenutno registriran samo za zdravljenje krvavitev pri bolnikih s hemofilijo A in B, ki imajo prisotne inhibitorje, se zaradi svojega načina delovanja ponuja kot nekakšno univerzalno zdravilo pri vseh neobvladljivih krvavitvah. Učinkovitost rFVIIa je posledica njegovega od tkivnega faktorja (TF) in ravni motnje v koagulacijskem sistemu neodvisnega delovanja, ki vodi k nastanku velikih količin trombina. Zdi se, da je njegovo delovanje omejeno samo na mesto poškodbe/krvavitve. Zaključki. Krvavitev pri kirurškem bolniku in poškodovancu je iz dveh delov. Prva je krvavitev iz velikih žil, ki jo je mogoče oskrbeti samo kirurško, druga pa je posledična koagulopatska krvavitev. Koagulopatska krvavitev je posledica porabne in dilucijske koagulopatije, hipotermije, multitransfuzijskega sindroma in metaboličnih sprememb pri bolniku. rFVlla učinkuje na koagulopatsko krvavitev. Ker pa je pogoj za učinkovito zdravljenje z rFVlla hkrati pravilno nadomestno zdravIjenje s krvnimi pripravki, je potrebno v zdravljenje vključiti specialista hematologa. Največ primerov učinkovite uporabe rFVlla je povezanih s področjem travmatologije. Univerzalna priporočila, kdaj pri poškodovancu z neobvladljivo krvavitvijo k zdravljenju dodati rFVlla, niso izdelana. Ker pa imajo z uporabo rFVlla pri travmatoloških bolnikih največ izkušenj v Izraelu, imajo izraelska priporočila največjo uporabno vrednost. rFVlla so večkrat uporabili tudi pri različnih medoperativnih in pooperativnih krvavitvah. Opisana so klinična testiranja in uporaba pri operacijah prostate, operacijah srca in velikih žil in presaditvi jeter. Poročila navajajo učinkovito uporabo zdravila tudi na področjih nevrologije in nevrokirurgije (možganske krvavitve) ter porodništva in ginekologije. (Izvleček skrajšan pri 2000 znakih).
Descriptors		FACTOR VIIA RECOMBINANT PROTEINS HEMOPHILIA HEMOSTASIS, SURGICAL DISSEMINATED INTRAVASCULAR COAGULATION WOUNDS AND INJURIES HEMORRHAGE HEMODILUTION ANTICOAGULANTS THROMBOCYTOPENIA BLOOD PLATELET DISORDERS