Recombinant Factor VIIa
NovoSeven RT
Recombinant activated factor VII (procoagulant)
Activates the extrinsic pathway at the site of tissue-factor exposure → thrombin burst. Localized hemostasis.
Indications
- •Hemophilia A/B with inhibitors
- •Factor VII deficiency
- •Glanzmann thrombasthenia
- •Off-label refractory surgical/trauma bleeding (last-resort)
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Hemophilia with inhibitors | 90 mcg/kg IV q2h until hemostasis | — |
| Off-label bleeding | Institution protocol (e.g., 20–90 mcg/kg) — last resort | — |
Pharmacokinetics
Onset minutes. Half-life ~2.5 h. Requires some fibrinogen + platelets to work.
Side effects
- !Arterial + venous thrombosis (MI, stroke)
- !Expensive
- !Ineffective if fibrinogen/platelets/pH grossly deranged
Contraindications
- ×Known thrombotic tendency (relative)
Clinical pearls
- ★Off-label 'rescue' for catastrophic bleeding — correct fibrinogen, platelets, pH, calcium, and temperature FIRST or it won't work.
- ★Real arterial thrombotic risk — not a routine hemostatic.
Other drugs in Coagulation Related
- Heparin (unfractionated)
Activates antithrombin → inactivates IIa (thrombin) and Xa.
- Tranexamic Acid (TXA)
Reversibly binds plasminogen, blocking conversion to plasmin → preserves fibrin clot.
- Protamine Sulfate
Strongly basic (positive-charge) protein binds to highly acidic (negative-charge) heparin → inactive ionic complex → renal excretion. 1 mg protamine neutralizes ~100 units heparin.
- DDAVP (Desmopressin)
Selective V2 agonist (renal water retention + Factor VIII/vWF release from endothelial Weibel-Palade bodies). NO V1 vasopressor activity at therapeutic dose.
- Warfarin
Inhibits vitamin K epoxide reductase (VKORC1) → depletes reduced vitamin K → ↓ synthesis of factors II, VII, IX, X and proteins C/S. Full effect takes days (waits for existing factor decay).
- Enoxaparin
Antithrombin-mediated inhibition, weighted toward factor Xa over IIa (~3.8:1). More predictable than UFH — no routine monitoring.
- Dalteparin
Antithrombin-mediated factor Xa > IIa inhibition. Similar profile to enoxaparin; preferred LMWH in cancer-associated VTE (CLOT trial).
- Tinzaparin
Antithrombin-mediated factor Xa > IIa inhibition; higher mean molecular weight than enoxaparin (anti-Xa:IIa ~1.9:1).
Browse all classes: /reference/drugs
Suggested reading
- •Miller's Anesthesia, 9e
- •FDA package insert
