We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence |

Administration of Recombinant Activated Factor VII in Major Thoracic Operations

Ali-Asghar Alavi, MD; Sayed Mahdi Jalali, MD; Mohammad R. Rasouli, MD; Payam Eghtesadi-Araghi, MD
Arch Surg. 2008;143(10):1021. doi:10.1001/archsurg.143.10.1021-a.
Text Size: A A A
Published online


We would like to make some points regarding the valuable article by Ranucci et al1 published in the March issue of the Archives. The authors reviewed randomized clinical trials of the administration of recombinant factor VII (rFVII) in major operations. In their meta-analysis, they showed that, in major operations, rFVII can reduce use of red blood cell units. Most of these studies have been performed in cardiac operations and liver transplantation. In some major operations, such as thoracic operations, we do not have enough evidence2 about the efficacy and safety of rFVII. In a randomized controlled trial, we evaluated the effect of rFVII on 40 patients who underwent elective thoracic operations (20 of whom received 90 μg of rFVII per kilogram of bodyweight preoperatively). In our study, there were no significant differences regarding perioperative bleeding (intraoperatively and 2 days later) and use of blood products (P > .05) between the 2 groups. Also, no complications were seen. In this study, we excluded patients who needed emergency operations. Also, no patient in this study had liver disease, renal failure, or acquired or congenital bleeding disorders, which have been previously described by Filsoufi et al3 as risk factors for massive perioperative bleeding. Thus, according to our study and other articles4,5 that failed to show the efficacy of rFVII, it seems that, besides the other well-defined risk factors, type of operation (emergent or elective) is an important determinant for the efficacy of rFVII.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles