Factor VII:C was determined by a one-stage method using high-sensitivity human thromboplastin, performed on BCS coagulometer. The prothrombin time (PT) was also performed on BCS coagulometer. All patients underwent surgery under coverage of rFVIIa (NovoSeven; Novo Nordisk, Gentofte, Denmark). The treatment regimen consisted in three doses of rFVIIa

administered every 8 h on surgery day (day 0, D0) followed by regular administrations of rFVIIa every 12 or 24 h for the next 9–14 days depending on the type of surgery. At the time of study rFVIIa for surgical interventions was available in three potencies (1, 2 and 5 mg per bottle) therefore we decided to round the calculated doses up or down on individual basis to avoid product waste. We decided that learn more the pre-surgery rFVIIa dose should be not less than 30 μg kg−1 in patients with FVII:C ≤ 2 IU dL−1 and about 20 μg kg−1 in patients with FVII:C > 2 IU dL−1. The subsequent doses were about 15 μg kg−1 (Table 1). We did not adjust the rFVIIa doses according to the FVII:C and PT results although STA-9090 in vivo both parameters were determined on daily basis. Treatment monitoring was therefore

based on the perioperative clinical course including blood loss or haematoma formation. Antithrombotic prophylaxis was used in accordance with the American College of Chest Physicians recommendations [11]. We did not use antifibrinolytics. Patient no 01 is a 78-year-old woman suffering from severe FVII deficiency (FVII:C 2 IU dL−1); she presented several spontaneous and trauma-provoked bleeds to knees and hips which were treated with FFP and PCC. She demonstrated

reduced range of motion (ROM) of the right hip, significant degenerative changes in the joint on the X-ray examination, as well as rest and night pain treated with narcotic analgesics. Concomitant disorders were: arterial hypertension, paroxysmal atrial fibrillation and ischaemic heart disease (percutaneous coronary intervention without stent placement 10 years earlier, currently without antithrombotic agents) and gall stones. Total hip replacement from a posterior approach with cemented MCE公司 implant was performed. Examination of cartilage, bone and synovium specimens taken intra-operatively for pathological tests revealed macroscopic and microscopic features of idiopathic coxarthrosis rather than blood-induced arthropathy. On D0 the first dose of rFVIIa (31.7 μg kg−1) was given 15 min prior surgery, followed by 15.8 μg kg−1 given 8 and 16 h after the first dose. From day 1 (D1) till day 12 (D12) after surgery she received rFVIIa at a dose of 15.8 μg kg−1 every 12 h (Table 2). FVII:C trough plasma levels in the post-operative period ranged from 6 to 8 IU dL−1 (on D1 – 7 IU dL−1). Twenty four hours after procedure thromboprophylaxis with low-molecular weight heparin (LMWH) (enoxaparin 40 mg daily) was introduced and continued for 12 days.