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.
  • *Sint Maartenskliniek, Nijmegen, The Netherlands.
Article Information
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.
Slappendel R, Huvers FC, Benraad B, Novakova I, van Hellemondt GG: Use of recombinant factor VIIa (NovoSeven) to reduce postoperative bleeding after total hip arthroplasty in a patient with severe cirrhosis and thrombocytopenia. A nesthesiology 2002; 96: 1525–7Slappendel, R Huvers, FC Benraad, B Novakova, I van Hellemondt, GG
Linden JV, Wagner K, Voytovich AE, Sheehan J: Transfusion errors in New York State: An analysis of 10 years’ experience. Transfusion 2000; 40: 1207–13Linden, JV Wagner, K Voytovich, AE Sheehan, J
Blumberg N: Allogenic transfusion and infection: Economic and clinical implications. Semin Hematol 1997; 34: 34–40Blumberg, N
Murphy P, Heal JM, Blumberg N: Infection or suspected infection after hip replacement surgery with autologous or homologous blood transfusions. Transfusion 1991; 31: 212–7Murphy, P Heal, JM Blumberg, N
Bierbaum BE, Callaghan JJ, Galante JO, et al.: An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 1999; 81: 2–10Bierbaum, BE Callaghan, JJ Galante, JO
Innerhofer P, Walleczek C, Luz G, et al.: Transfusion of buffy coat-depleted blood components and risk of postoperative infection in orthopedic patients. Transfusion 1999; 39: 625–32Innerhofer, P Walleczek, C Luz, G
Borghi B, Casati A: Incidence and risk factors for allogenic blood transfusion during major joint replacement using an integrated autotransfusion regimen. The Rizzoli Study Group on Orthopaedic Anaesthesia. Eur J Anaesthesiol 2000; 17: 411–7Borghi, B Casati, A