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Recombinant Factor VIIa plus Surgery for Intracerebral Hemorrhage

Published online by Cambridge University Press:  02 December 2014

Christina S. Sutherland ,
Michael D. Hill ,
Anthony M. Kaufmann ,
Joseph A. Silvaggio ,
Andrew M. Demchuk  and
Garnette R. Sutherland
Christina S. Sutherland
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB
Michael D. Hill*
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB
Anthony M. Kaufmann
Affiliation:
Section of Neurosurgery, University of Manitoba, Winnipeg, MB, Canada
Joseph A. Silvaggio
Affiliation:
Section of Neurosurgery, University of Manitoba, Winnipeg, MB, Canada
Andrew M. Demchuk
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB
Garnette R. Sutherland
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Calgary, AB
*
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Rm 1162, 1403 29th Street NW, Calgary, Alberta, T2N 2T9, Canada.
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Abstract

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Background:

Hyperacute surgical evacuation of intracerebral hemorrhage is associated with a high rebleeding rate. The peri-operative administration of rFVIIa to patients with intracerebral hemorrhage may decrease the frequency of post-operative hemorrhage, and improve outcome.

Methods:

Patients receiving recombinant activated factor VII (rFVIIA) therapy immediately prior to acute surgery were collected at two centres. The intracerebral hemorrhage (ICH) score and ICH Grading Scale were determined, as was long-term outcome using the modified Rankin Scale. Residual/ recurrent clot was evaluated by comparing pre-operative to post-operative CT scans.

Results:

Fifteen patients with intracerebral hemorrhage received 40-90 μg/kg of rFVIIa and underwent surgical hematoma evacuation at a median time of five hours following symptom onset. Median pre-operative clot volume was 60 ml, decreasing to 2 ml post-operatively. There were no thromboembolic adverse events. Thirteen patients survived, 11 (73%) were independent, and two (13%) had a moderate to severe disability. These outcomes were significantly better than expected based on the median ICH score (40% mortality) and based on median ICH Grading Scale (18% good outcome).

Conclusions:

The pre or peri-operative administration of rFVIIa resulted in minimal residual or recurrent hematoma volume and may be an important adjunct to surgery in patients with intracerebral hemorrhage.

Résumé:

RÉSUMÉ:Contexte:

L°évacuation chirurgicale hyperaigué de l°hémorragie intracérébrale est associée à un taux élevé de resaignement. L” administration de rFVIIa périopératoire chez les patients présentant une hémorragie intracérébrale pourrait diminuer la fréquence des hémorragies postopératoires et améliorer l°issue.

Méthodes:

Les patients ayant reçu du rFVIIa immédiatement avant la chirurgie ont été identifiés dans deux centres. Les scores du ICH et du ICH Grading Scale ont été déterminés de même que l°issue à long terme au moyen du Modified Rankin Scale. Le caillot résiduel ou récurrent a été évalué en comparant les CT scans préopératoires et postopératoires.

Résultats:

Quinze patients ayant présenté une hémorragie intracérébrale ont reçu de 40 à 90 μg/kg de rFVIIa et ont subi une évacuation chirurgicale de l°hématome 5 heures (temps médian) apres le début des symptômes. Le volume médian du caillot avant la chirurgie était de 60 ml et de 2 ml apres la chirurgie. Aucun incident thromboembolique n°a été observé. Treize patients ont survécu dont 11 (73%) étaient indépendants et 2 (13%) avaient une invalidité de modérée à sévère. Ces résultats étaient significativement meilleurs qu°anticipés vu le score médian du ICH (40% de mortalité) et du ICH Grading Scale (l8% de bons résultats).

Conclusions:

Un hématome résiduel ou récurrent dont le volume était minime a été observé suite à l”administration pré ou périopératoire de rFVIIa. Le rFVIIa peut être un traitement d°appoint important à la chirurgie chez les patients présentant une hémorragie intracérébrale.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 5 , November 2008 , pp. 567 - 572
Copyright
Copyright © The Canadian Journal of Neurological 2008

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