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BJA Advance Access published online on June 18, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aen175
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© 2008 The Author(s)
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Effect of haemodilution, acidosis, and hypothermia on the activity of recombinant factor VIIa (NovoSeven®)

D. Viuff1,*,{dagger}, B. Lauritzen1,{dagger}, A.E. Pusateri2,{dagger}, S. Andersen1,{dagger}, R. Rojkjaer2,{dagger} and P.I. Johansson3,{dagger}

1 Hemostasis Pharmacology, Novo Nordisk A/S, Novo Nordisk Park, 2760 Måløv, Denmark
2 Novo Nordisk Research US (NNRUS), North Brunswick, NJ, USA
3 HS Bloodbank, Rigshospitalet, Copenhagen, Denmark

* Corresponding author. E-mail: dviu{at}novonordisk.com

Background: A range of plasma volume expanders is used clinically, often in settings where haemostasis may already be impaired. The haemostatic agent, recombinant activated factor VII (rFVIIa, NovoSeven®), may be used to improve haemostasis but potential interactions with different volume expanders are poorly understood.

Methods: Clot formation was measured by thromboelastography (TEG) using blood from healthy volunteers. In vitro effects of rFVIIa with haemodilution, acidosis, and hypothermia were examined. Conditions were induced by dilution with NaCl (0.9%), lactated Ringer's solution, albumin 5%, or hydroxyethyl starch (HES) solutions [MW (molecular weight) 130–670 kDa]; by adjusting pH to 6.8 with 1 M HEPES (N-2-hydroxyethylpiperazine-N'-2-ethanesulphonic acid) buffer; or by reducing temperature to 32°C. We also studied the effect of low vs high MW HES (MW 200 vs 600 kDa) and rFVIIa on in vivo bleeding time (BT) in rabbits.

Results: Haemodilution progressively altered TEG parameters. rFVIIa improved TEG parameters in the presence of acidosis, hypothermia or 20% haemodilution (P<0.05). At 40% haemodilution, the rFVIIa effect was diminished particularly with high MW HES. In vivo, rFVIIa shortened the BT (P<0.05) with low but not high MW HES.

Conclusions: Efficacy of rFVIIa was affected by the degree of haemodilution and type of volume expander, but not by acidosis or hypothermia.

Keywords: blood, haemodilution; complications, acidosis; hypothermia; measurement techniques, thromboelastography; rFVIIa; surgery, haemostatic response

{dagger} Declaration of interest. With the exception of Dr P.I.J., all authors are employees of Novo Nordisk. P.I.J. is funded by Novo Nordisk. The product used in this paper has been launched by Novo Nordisk.


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Effect of haemodilution, acidosis, and hypothermia on the activity of recombinant factor VIIa
Hadi Meeran Hussain
British Journal of Anaesthesia, 5 Sep 2008 [Full text]

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