Failure of recombinant activated factor VII during surgery in a hemophiliac with high-titer factor VIII antibody

Recombinant activated factor VII (rFVIIa) was used before and after inguinal hernioplasty to prevent bleeding in a patient with hemophilia A complicated by a high-potency antifactor VIII inhibitor. rFVIIa (75 micrograms/kg) was given before and after surgery, first by bolus infusions at intervals of 2-3 h for 47 h and then by continuous intravenous infusion at a rate of 38 micrograms/h for an additional period of 12 h. Although no undue bleeding was observed during and for the first 26 h after surgery, the patient subsequently developed wound bleeding and hematomas that necessitated blood transfusion and infusion of porcine factor VIII. This case indicates that rFVIIa is not always successful in patients with antifactor VIII inhibitor and that more experience is needed to establish the optimal doses at surgery