Acute Bleeding Management

FVIIa (NovoSeven®) is the recommended initial therapy. For full details, see

The use of NovoSeven® may be considered in 2 situations.

The management of bleeding in patients with Factor VIII and Factor IX inhibitors (see the New Zealand National Guidelines for the Management of Haemophilia).
The management of life threatening bleeding with coagulopathy.

NovoSeven® is recombinant human coagulation factor VII (rFVIIa). It promotes haemostasis by activating the extrinsic pathway of the coagulation cascade. When complexed with tissue factor, rFVIIa can activate coagulation factor X to Xa and factor IX to IXa. Factor Xa complexed with other factors then converts prothrombin to thrombin leading to the formation of a haemostatic plug. Following infusion the half life in normal subjects is just over 2 hours.

Indications

This agent should be considered for the treatment of patients with haemophilia A or B with inhibitors and who are bleeding. It may also be used in the treatment of massive haemorrhage requiring large volumes of replacement blood and plasma.

Preparation Available

Vial sizes are 1.2mg, 2.4mg and 4.8mg. The product is stored in the CDHB Pharmacy. During 2010 there will be a phased switch-over to the newer room-temperature-stable NovoSeven with vial sizes of 1 mg, 2 mg or 5 mg.

Recommended Dose

For life threatening bleeding 100 mcg/kg rounded to the nearest vial size. Repeat in 20 minutes if no response, and adhere to the national guidelines for appropriate NovoSeven usage.

Adverse Effects

NovoSeven® is contraindicated in anyone known to have hypersensitivity to mice, hamsters or bovine products. There is a risk that this agent may provoke thrombosis but the degree of this risk is not known.

For further information concerning this agent, see the Medsafe database.

In all situations, the use of NovoSeven® is controlled by the Haematologist.

Use only at the direction of a specialist haematologist involved with haemophilia care.

Refer to the National Haemophilia Guidelines, page 17, for full details of management of major and minor bleeds in patients with VIII inhibitors. The use of Novo Seven® and FEIBA is described here as well as Immune Tolerance Therapy, IVIg and immunosuppression. Patients with inhibitors to FVIII, either inherited or acquired, present complex problems. Consult the haematologist as soon as possible.


About this Canterbury DHB document (5269):
Document Owner:	Sean Macpherson (see Who's Who)
Last Reviewed:	November 2019
Next Review:	November 2022
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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