RESUMEN
Acquired hemophilia A in postoperative patients can cause major bleeding and an accurate diagnosis is required for effective treatment. Standard treatment is costly, difficult to obtain, and takes 4 to 6 weeks to be effective. This article describes a patient successfully treated with recombinant factor VIIa, porcine factor VIII, plasmapheresis, rituximab, and high-dose corticosteroids.
Asunto(s)
Hemofilia A/diagnóstico , Hemofilia A/etiología , Hemorragia Posoperatoria/tratamiento farmacológico , Hemorragia Posoperatoria/etiología , Corticoesteroides/administración & dosificación , Animales , Factor VIII/administración & dosificación , Factor VIIa/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Plasmaféresis , Proteínas Recombinantes/administración & dosificación , Rituximab/administración & dosificación , Porcinos , Resultado del TratamientoRESUMEN
BACKGROUND: Direct peritoneal resuscitation (DPR) is associated with improved outcomes in trauma. Animal models suggest DPR has favorable effects on the liver. We sought to evaluate its safety and assess for improved outcomes in liver transplantation (LT). METHODS: LT patients with renal dysfunction and/or obesity were enrolled in a phase-I clinical trial. DPR lasted 8-24 âh depending on postoperative disposition. Primary outcome was percent of patients completing DPR. Secondary outcomes evaluated complications. Controls with either obesity (control-1) or both risk factors (obesity â+ ârenal dysfunction, control-2) were analyzed. RESULTS: Fifteen patients were enrolled (seven with both criteria and eight with obesity alone). DPR was completed in 87 â% of patients, with one meeting stopping criteria. Controls included 45 (control-1) and 24 (control-2) patients. Return to operating room, graft loss, and late infections were lower with DPR. CONCLUSION: DPR appears to be safe in closed abdomens following LT, warranting a follow-up phase-II trial to assess efficacy.