Should the Dose of Recombinant Activated Factor VII Be Adjusted for Morbidly Obese Patients? Balancing Risk of Bleeding With Thrombosis

Nick W. Lonardo, Lynn F. Lonardo, Mary C. Mone, Heidi J. Simons, Richard G. Barton

Abstract


This case report compared and contrasted calculations for dosing recombinant activated factor VII (rFVIIa) in a morbidly obese patient using estimation of blood volume rather than actual weight or ideal body weight (IBW). A specific case report in a morbidly obese, critically ill patient with new diagnosis of acquired hemophilia A (AHA) was presented. A 64-year-old morbidly obese patient with AHA required emergent surgery for perforated diverticulitis and peritonitis. The patient required bypass treatment with rFVIIa and was initially dosed based on actual weight of 167 kg (body mass index 61). The patient had a history of deep vein thrombosis and new onset of atrial fibrillation. Based on numerous risk factors for both bleeding and the potential for thromboembolism, the rFVIIa dose was adjusted based on calculations using adjusted body weight and blood volume principles, which decreased dosage by 40%, from 15 to 9 mg. With no active bleeding, rFVIIa dosage was adjusted and rotating thromboelastography testing was added to coagulation parameter monitoring. With this change in dosage, hemostasis was maintained and 132 mg of rFVIIa was saved over an 8-day treatment period. There is very limited literature to direct clinicians on rFVIIa dosing in morbidly obese patients. Since obesity is prevalent in all patient populations, clinicians should consider an estimation of blood volume as a means to dose rFVIIa. Adjusting the dose of rFVIIa to account for changes in blood volume is a physiologic target that should help balance the risk of underdosing using IBW and the risk of overdosing using actual body weight.




J Hematol. 2016;5(2):60-66
doi: http://dx.doi.org/10.14740/jh256w


Keywords


Coagulation factors; Morbid obesity; Blood volume; Recombinant activated factor VII; Ideal body weight; Adjusted body weight; Body mass index

Full Text: HTML PDF
 
Home     |     Log In     |      About     |      Search     |      Current     |      Archives     |      Submit      |     Subscribe


 

     

Aims and Scope

Current Issues

Conflict of Interest

About Publisher

Editorial Board

Archives

Copyright

Company Profile

Editorial Office

Misconduct and Retraction

Permissions

Company Registration

Contact Us

Abstracting and Indexing

ICMJE

Ownership

Instructions to Authors

Access

Declaration of Helsinki

Contact Publisher

Submission Checklist

Reprints

Terms of Use

Company Address

Submit a Manuscript

Open Access Policy

Privacy Policy

Browse Journals

Publishing Fee

Publishing Policy

Disclaimer

Recent Highlights

Peer-Review Process

Publishing Quality

Code of Ethics

Advertising Policy

Manuscript Tracking

Advanced Search

For Librarians

Careers

Publishing Process

Publication Frequency

For Reviewers

Propose a New Journal

       
       

Journal of Hematology, quarterly, ISSN 1927-1212 (print), 1927-1220 (online), published by Elmer Press Inc.               
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC BY-NC 4.0)



This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.thejh.org    editorial contact: editor@thejh.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada
 

© Elmer Press Inc. All Rights Reserved.

IMPORTANT: THIS JOURNAL SITE OUTLOOK IS DESIGNED BY THE PUBLISHER AND COPYRIGHT PROTECTED. DO NOT COPY!