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Use of Recombinant Factor VIIa to Correct the Coagulation Status of Individuals with Advanced Liver Disease Prior to a Percutaneous Liver Biopsy

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Abstract

Objectives Percutaneous liver biopsies are used to grade and stage liver disease and are also useful in monitoring the progress of liver disease over time as well as the response to medical therapies. The present study was undertaken to assess the effectiveness of recombinant factor VIIa as a means of transiently correcting the coagulopathy, enabling the safe performance of a percutaneous liver biopsy in patients in whom the use of fresh-frozen plasma is not possible without precipitating pulmonary edema or who have a treatment induced (iatrogenic) coagulopathy. Methods The subjects of this report consisted of 18 consecutive individuals with advanced disease induced, and 15 with a therapeutic iatrogenic-induced, coagulopathy. All biopsies were performed by a single hepatologist. Before and 6 h after each biopsy, a prothrombin time and partial thromboplastin time was obtained from each subject. Mean values ± the standard error of the mean were obtained using the independent samples T-test. Results Recombinant factor VIIa had a marked effect in transiently correcting the mean prothrombin time in these subjects allowing for a safe complication free percutaneous biopsy in this high-risk group. Conclusions Recombinant factor VIIa could be used to obtain a clinically indicated liver biopsy in severely ill patients, who without this therapeutic agent, would either not be biopsied or, if biopsied, would require much longer hospitalization and the use of fresh-frozen plasma (with its risks of volume overload and infection).

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References

  1. Spycher C, Zimmermann A, Reichen J. The diagnostic value of liver biopsy. BMC Gastroenterol. 2001;1:12. doi:10.1186/1471-230X-1-12.

    Article  PubMed  CAS  Google Scholar 

  2. Stuart KL, Bras G, Patrick SJ, et al. Further clinical and investigative uses of liver biopsy; an analysis of five hundred-twenty-seven biopsies. Arch Intern Med. 1958;101(1):67–83.

    CAS  Google Scholar 

  3. Ishak K, Baptista A, Bianchi L, et al. Histological grading and staging of chronic hepatitis. J Hepatol. 1995;22(6):696–699. doi:10.1016/0168-8278(95)80226-6.

    Article  PubMed  CAS  Google Scholar 

  4. Franciscus A. Grading and staging a liver biopsy. Information from Hepatitis C Support Project (HCSP); 2006.

  5. Gondal R. Evaluating liver disease in chronic viral hepatitis: indication and role of liver biopsy. J Gastroenterol Hepatol. 2004;19:S338–S341. doi:10.1111/j.1440-1746.2004.03698.x.

    Article  Google Scholar 

  6. Ansell ID. The uses of liver biopsy. Postgrad Med J. 1969;45(521):202–207. doi:10.1136/pgmj.45.521.202.

    Article  PubMed  CAS  Google Scholar 

  7. Bravo AA, Sheth SG, Chopra S. Liver Biopsy. N Engl J Med. 2001;344:495–500. doi:10.1056/NEJM200102153440706.

    Article  PubMed  CAS  Google Scholar 

  8. Lebrec D. Various approaches to obtaining liver tissue—choosing the biopsy technique. J Hepatol. 1996;25(1):20–24. doi:10.1016/S0168-8278(96)80065-1.

    Article  PubMed  Google Scholar 

  9. Fresh frozen plasma. Indications and risks. NIH Consensus Development Conference Statement 1984; 5(5):1–12.

  10. Youssef WI, Salazar F, Dasarathy S, et al. Role of fresh-frozen plasma infusion in correction of coagulopathy of chronic liver disease: a dual phase study. Am J Gastroenterol. 2003;98:1391–1394. doi:10.1111/j.1572-0241.2003.07467.x.

    Article  PubMed  Google Scholar 

  11. O’Shaughnessy DF, Atterbury C, Bolton Maggs P, et al. Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant. Br J Haematol. 2004;126(1):11–28.

    Article  PubMed  CAS  Google Scholar 

  12. Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology. 1996;24(2):289–293.

    Article  PubMed  CAS  Google Scholar 

  13. Kositchaiwat C, Chuansumrit A. Experiences with recombinant factor VIIa for the prevention of bleeding in patients with chronic liver disease undergoing percutaneous liver biopsies and endoscopic retrograde cholangiopancreatography (ERCP). Thromb Haemost. 2001;86(4):1125–1126.

    PubMed  CAS  Google Scholar 

  14. Al Sobhi A. Successful outcome of using recombinant activated factor VII (rFVIIa) in liver biopsy in a patient with liver failure. J Thromb Haemost. 2006;4((9):2073–2074.

    Article  PubMed  CAS  Google Scholar 

  15. Jaffers L, Chalasani N, Balart L, et al. Safety and efficacy of recombinant factor VIIa in patients with liver disease undergoing laproscopic liver biopsy. Gastroenterology. 2002;123(1):118–126.

    Article  Google Scholar 

  16. Carvalho A, Leitao J, Louro E, et al. Small dose of recombinant factor VIIa (rFVIIa) to perform percutaneous liver biopsies in cirrhotic patients. Rev Esp Enferm Dig. 2002;94(5):280–285.

    PubMed  CAS  Google Scholar 

  17. Bernstein D. Effectiveness of the recombinant factor VIIa in patients with the coagulopathy of advanced Child’s B and C cirrhosis. Semin Thromb Hemost. 2000;26:437–438.

    Article  PubMed  CAS  Google Scholar 

  18. Bernstein DE, Jeffers L, Erhardtsen E, et al. Recombinant factor VIIa corrects prothrombin time in cirrhotic patients: a preliminary study. Gastroenterology. 1997;113(6):1930–1937.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. St. Luke’s Medical Center, Aurora Health Care, Milwaukee, WI, 53215, USA

    Shabbar Sajjad, Moises Garcia, Ahmed Malik, Magdalena M. George & David H. Van Thiel

  2. Division of Gastroenterology/Section of Hepatology, Department of Medicine, Rush University Medical Center, Professional Office Building, 1725 W. Harrison Street, Suite 158, Chicago, IL, 60612, USA

    David H. Van Thiel

Authors
  1. Shabbar Sajjad
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  2. Moises Garcia
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  3. Ahmed Malik
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  4. Magdalena M. George
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  5. David H. Van Thiel
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Correspondence to David H. Van Thiel.

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Sajjad, S., Garcia, M., Malik, A. et al. Use of Recombinant Factor VIIa to Correct the Coagulation Status of Individuals with Advanced Liver Disease Prior to a Percutaneous Liver Biopsy. Dig Dis Sci 54, 1115–1119 (2009). https://doi.org/10.1007/s10620-009-0753-0

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  • DOI: https://doi.org/10.1007/s10620-009-0753-0

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