Rationale for the Potential Use of Recombinant Activated Factor
VII in Severe Post-Partum Hemorrhage

J 2024

Rationale for the Potential Use of Recombinant Activated Factor VII in Severe Post-Partum Hemorrhage

ACS, Nandor, Wolfgang C KORTE, Christian C VON HEYMANN, Jerzy WINDYGA, Jan BLATNÝ et. al.

Základní údaje

Originální název

Rationale for the Potential Use of Recombinant Activated Factor VII in Severe Post-Partum Hemorrhage

Autoři

ACS, Nandor, Wolfgang C KORTE, Christian C VON HEYMANN, Jerzy WINDYGA a Jan BLATNÝ (203 Česká republika, domácí)

Vydání

Journal of Clinical Medicine, Basel, MDPI, 2024, 2077-0383

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30204 Oncology

Stát vydavatele

Švýcarsko

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 3.900 v roce 2022

Organizační jednotka

Lékařská fakulta

DOI

http://dx.doi.org/10.3390/jcm13102928

UT WoS

001234852000001

Klíčová slova anglicky

massive post-partum hemorrhage; Novo Seven; obstetric hemorrhage; rFVIIa mode of action

Štítky

14110321, rivok

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 20. 8. 2024 12:05, Mgr. Tereza Miškechová

Anotace

V originále

Severe post-partum hemorrhage (PPH) is a major cause of maternal mortality worldwide. Recombinant activated factor VII (rFVIIa) has recently been approved by the European Medicines Agency for the treatment of severe PPH if uterotonics fail to achieve hemostasis. Although large randomized controlled trials are lacking, accumulated evidence from smaller studies and international registries supports the efficacy of rFVIIa alongside extended standard treatment to control severe PPH. Because rFVIIa neither substitutes the activity of a missing coagulation factor nor bypasses a coagulation defect in this population, it is not immediately evident how it exerts its beneficial effect. Here, we discuss possible mechanistic explanations for the efficacy of rFVIIa and the published evidence in patients with severe PPH. Recombinant FVIIa may not primarily increase systemic thrombin generation, but may promote local thrombin generation through binding to activated platelets at the site of vascular wall injury. This explanation may also address safety concerns that have been raised over the administration of a procoagulant molecule in a background of increased thromboembolic risk due to both pregnancy-related hemostatic changes and the hemorrhagic state. However, the available safety data for this and other indications are reassuring and the rates of thromboembolic events do not appear to be increased in women with severe PPH treated with rFVIIa. We recommend that the administration of rFVIIa be considered before dilutional coagulopathy develops and used to support the current standard treatment in certain patients with severe PPH.

Citovat

ACS, Nandor, Wolfgang C KORTE, Christian C VON HEYMANN, Jerzy WINDYGA a Jan BLATNÝ. Rationale for the Potential Use of Recombinant Activated Factor VII in Severe Post-Partum Hemorrhage. Journal of Clinical Medicine. Basel: MDPI, 2024, roč. 13, č. 10, s. 1-8. ISSN 2077-0383. Dostupné z: https://dx.doi.org/10.3390/jcm13102928.

@article{2424063,
   author = {Acs, Nandor and Korte, Wolfgang C and von Heymann, Christian C and Windyga, Jerzy and Blatný, Jan},
   article_location = {Basel},
   article_number = {10},
   doi = {http://dx.doi.org/10.3390/jcm13102928},
   keywords = {massive post-partum hemorrhage; Novo Seven; obstetric hemorrhage; rFVIIa mode of action},
   language = {eng},
   issn = {2077-0383},
   journal = {Journal of Clinical Medicine},
   title = {Rationale for the Potential Use of Recombinant Activated Factor VII in Severe Post-Partum Hemorrhage},
   url = {https://www.mdpi.com/2077-0383/13/10/2928},
   volume = {13},
   year = {2024}
}

TY  - JOUR
ID  - 2424063
AU  - Acs, Nandor - Korte, Wolfgang C - von Heymann, Christian C - Windyga, Jerzy - Blatný, Jan
PY  - 2024
TI  - Rationale for the Potential Use of Recombinant Activated Factor VII in Severe Post-Partum Hemorrhage
JF  - Journal of Clinical Medicine
VL  - 13
IS  - 10
SP  - 1-8
EP  - 1-8
PB  - MDPI
SN  - 20770383
KW  - massive post-partum hemorrhage
KW  - Novo Seven
KW  - obstetric hemorrhage
KW  - rFVIIa mode of action
UR  - https://www.mdpi.com/2077-0383/13/10/2928
N2  - Severe post-partum hemorrhage (PPH) is a major cause of maternal mortality worldwide. Recombinant activated factor VII (rFVIIa) has recently been approved by the European Medicines Agency for the treatment of severe PPH if uterotonics fail to achieve hemostasis. Although large randomized controlled trials are lacking, accumulated evidence from smaller studies and international registries supports the efficacy of rFVIIa alongside extended standard treatment to control severe PPH. Because rFVIIa neither substitutes the activity of a missing coagulation factor nor bypasses a coagulation defect in this population, it is not immediately evident how it exerts its beneficial effect. Here, we discuss possible mechanistic explanations for the efficacy of rFVIIa and the published evidence in patients with severe PPH. Recombinant FVIIa may not primarily increase systemic thrombin generation, but may promote local thrombin generation through binding to activated platelets at the site of vascular wall injury. This explanation may also address safety concerns that have been raised over the administration of a procoagulant molecule in a background of increased thromboembolic risk due to both pregnancy-related hemostatic changes and the hemorrhagic state. However, the available safety data for this and other indications are reassuring and the rates of thromboembolic events do not appear to be increased in women with severe PPH treated with rFVIIa. We recommend that the administration of rFVIIa be considered before dilutional coagulopathy develops and used to support the current standard treatment in certain patients with severe PPH.
ER  -

ACS, Nandor, Wolfgang C KORTE, Christian C VON HEYMANN, Jerzy WINDYGA a Jan BLATNÝ. Rationale for the Potential Use of Recombinant Activated Factor VII in Severe Post-Partum Hemorrhage. \textit{Journal of Clinical Medicine}. Basel: MDPI, 2024, roč.~13, č.~10, s.~1-8. ISSN~2077-0383. Dostupné z: https://dx.doi.org/10.3390/jcm13102928.

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