Factors affecting how to treat a Factor VII deficiency:
(1) bleeding into high risk areas (CNS, cardiothoracic, ophthalmic)
(2) severity of other bleeding
(3) cause of the bleeding (trauma or surgery vs spontaneous)
(4) Factor VII activity
(5) patient's tolerance to volume load
|
Factor VII Activity
|
Bleeding
|
Management
|
|
>= 25%
|
none
|
monitor patient
|
|
>= 25%
|
present
|
Factor VII therapy until controlled
|
|
< 25%
|
none
|
monitor patient closely, minimize risk for injury
|
|
< 25%
|
present
|
Factor VII therapy until controlled
|
Therapy is complicated due to the short half-life of factor VII (2-5 hours)
Therapy with fresh frozen plasma (FFP):
(1) initially 10-15 mL per kg
(2) maintenance 3-6 mL per kg every 6-8 hours until bleeding resolved
Therapy with rFVIIa:
(1) 20 micrograms per kg IV every 2 hours (roughly approximates one 1.2 mg vial).
(2) rFVIIa comes in 1.2, 2.4 and 4.8 mg vials.
Therapy with FFP and rFVIIa can be combined to meet the needs of the patient.
