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BJA Advance Access originally published online on May 23, 2007
British Journal of Anaesthesia 2007 99(2):221-225; doi:10.1093/bja/aem099
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Probable right atrial thrombus immediately after recombinant activated factor VII administration

G. Pang* and A. Donaldson

Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, Queensland 4006, Australia

* Corresponding author. E-mail: georgepang{at}hotmail.com

We report the finding of a probable right atrial thrombus in a 33-yr-old male patient with severe head, chest, and abdominal trauma. Refractory coagulopathy and gross haemodynamic instability ensued, which was only partially controlled with massive blood product transfusion and high-dose inotropic support during laparotomy. Continuous transoesophageal echocardiography revealed a probable atrial thrombus partially occluding the right ventricular inflow tract, which appeared immediately after the patient received 100 µg kg–1 of recombinant activated factor VII (rFVIIa) via a left internal jugular central line. This is the first report documenting an immediate temporal relationship between rFVIIa administration and a space-occupying lesion compatible with localized thrombosis, despite ongoing severe systemic coagulopathy. We review the clinical use of rFVIIa and discuss possible factors contributing to this event.

Keywords: complications, thrombosis; complications, trauma; embolism, thromboembolism; transfusion, complications; safety, drug


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Mode of administration of factor VII - relation to thrombosis ?
Ivan Hronek MD
British Journal of Anaesthesia, 5 Oct 2007 [Full text]

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