Assessment of perioperative bleeding risk

A critical balance

Conditions not to miss

Operations not to miss

History is absolutely critical

Clinical Clues

Clinical clues

Family history

Drugs

Laboratory screen

Abnormal coagulation tests

Prolonged APPT

Abnormal coagulation tests

Prolonged PT

Controversy re the role of routine preop screening for U/L bleeding disorder

Hutchinson revised a questionnaire originally written by Rappaport. Reviewing these questions with each patient or parent will identify many bleeding disorders.

Slide 17

Use of Recombinant factor VIIa in massive bleeding

Definition Massive Blood Loss

Issues in massive transfusion settings

Impaired Haemostasis

Haemostatic effects of colloids

Dilutional Coagulopathy

Dilutional Coagulopathy

Dilutional Thrombocytopenia

Pharmacological techniques/agents

Slide 27

Practice Guidelines for component therapy in Massive Blood Loss

Slide 29

Activated Platelets

Slide 31

Only approved funded indication in Australia

Impaired Haemostasis in Massive Bleeding

Potential benefit of rFVIIa :

"Contraindications"

Current cost of one dose of NovoSeven:
(as at 1/7/2005)

Slide 37

Dose/Presentation/ Administration

Slide 39

Slide 40

"Recombinant activated factor VII for..."

1st USA case report of FVIIa in trauma

"Safety profile of recombinant factor..."

No of reported thrombotic events in haemophilia patients with inhibitors

Safety profile of rFVIIa

NovoSeven / Thrombosis

"Recombinant activated factor VII for..."

Royal Perth Hospital
Patient Characteristics

Coagulation Profile before and after rVIIa



Transfusion before and
 24 hours after rVIIa

Currently at RMH

Slide 52

Slide 53

Recombinant factor VIIa for life threatening post-partum haemorrhage

NovoSeven Summary