Novoseven

§        Serine protease

§        Physiologically the activated form is present in the circulation at 1%

§        Complexes with TF

§        Activates FX

§        Converts prothrombin to thrombin

§        Interaction of platelets FV, VIII and IX – THROMBIN BURST

§        rFVIIa may overcome deficiencies of individual clotting factors and platelets by accelerating the initial rate of thrombin generation

§        Half life is short – 2 hours

§        Theoretical risk of thrombosis

§        TF is expressed on circulating monocytes and endothelial cells in response to inflammatory cytokines in septicaemia

§        Gram-negative, endotoxin producing

§        TF can become exposed at sites of atherosclerotic plaque,

§        Many case reports when bleeding has been controlled in thrombocytopenia

Absolute contraindications

§        Thrombotic tendancy or recent atherosclerotic event

§        Sepsis and or DIC

§        Age <16

Indications

§        Massive blood loss

§        >1 blood volume in 2 hours

§        Continues despite

§        surgical re-exploration

§        Platelets >50

§        INR and APTT <1.5

§        Fibrinogen >1

§        2gm tranexamic acid

§        Factor VII deficiency

§        Glanzmann’s thrombasthenia

§        If antibodies to GPIIb/IIIa or HLA antibodies and platelet refractoriness

§        Haemophilia patients with inhibitors to VIII/ IX

§        JW with uncontrolled bleeding

Dose

§        90mcg/kg

§        Repeat at 1 hour if no effect and again at 2 hours

§        If no effect after 3 doses, STOP

§        Repeat bloods at 30 minutes

§        Dosing interval usually 2-3 hours