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Correspondence  |   April 2003
Use of Recombinant Activated Factor VII in Patients with Severe Coagulopathy and Bleeding: In Reply:
Author Affiliations & Notes
  • Robert Slappendel, M.D., Ph.D.
    *
Article Information
Correspondence
Correspondence   |   April 2003
Use of Recombinant Activated Factor VII in Patients with Severe Coagulopathy and Bleeding: In Reply:
Anesthesiology 4 2003, Vol.98, 1027. doi:
Anesthesiology 4 2003, Vol.98, 1027. doi:
In Reply:—
The reaction of Drs. Ho, Dion, and Karmakar in their letter to the editor is clear and simple: the best way to act on a dilution coagulopathy is to recognize it early and to treat it using adequate amounts of fresh frozen plasma. In our view, the main reason to avoid fresh frozen plasma or any homolog blood products in cases of orthopedic surgery 1 is also simple. Since the first human blood transfusion there have been unnecessary related risks: administration and handling mistakes 2, transmission viruses, transfusion reactions, and immunosuppression. 3–7 Transfusion-related immunosuppression is considered to favor postoperative infections, to perturb postoperative wound healing, and thereby to result in a protracted hospital stay. 3–7 
The availability of new recombinant DNA medicine, like recombinant activated factor VII, is very promising because of the nearly complete lack of side effects. We agree with Ho et al.  that treatment with fresh frozen plasma for dilution coagulopathy is, at present, the first choice. We expect that it's only a matter of time (for double-blinded, randomized trials) and money before recombinant DNA drugs such as recombinant activated factor VII replace (classic) coagulant drugs such as aprotinin and desmopressin.
References
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