Abstract
Peri- and early postoperative bleeding is a common complication of gynecologic surgery. We report four postmenopausal patients (age range, 58–72 years) who each received recombinant activated factor VII (rFVIIa; dose range, 17–70 μg/kg) to control severe postoperative hemorrhage associated with elective hysterectomy for benign uterine fibroids, carcinoma of the endometrium, cervical and uterine cancer, or metastatic carcinoma of the genital tract. Bleeding resolved within 12 hours in three patients after a single dose of rFVIIa. In the patient with metastatic disease, bleeding was markedly reduced after each of two doses of rFVIIa and resolved completely within 12 hours of the second dose. Supplemental blood product requirements (measured by units of packed red blood cells and fresh frozen plasma) were reduced, and coagulation status (prothrombin time, activated partial thromboplastin time) was generally improved postadministration. No thromboembolic complications occurred. Our findings suggest that recombinant FVIIa may offer an effective means of controlling bleeding associated with gynecologic surgery when conventional surgical and pharmacologic measures are unsuccessful; however, further investigation of the use of rFVIIa in this indication, preferably in the form of large, randomized clinical trials, is clearly needed. (J GYNECOL SURG 21:13)
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