Factor Eight Inhibitor Bypassing Activity (FEIBA) for Refractory Bleeding in Cardiac Surgery: Review of Clinical Outcomes

BACKGROUND: Refractory postoperative bleeding complicates a significant number of cardiac surgical procedures and results in both morbidity and mortality. Conventional strategies to effect hemostasis include surgical reexploration and administration of blood products. In some cases, bleeding remains intractable despite these methods, and alternatives are needed. Herein, we report our experience with the use of factor eight inhibitor bypassing activity (FEIBA), a coagulation factor concentrate, for refractory postoperative bleeding. METHODS: A retrospective review of the experience with FEIBA at a university-affiliated cardiac surgery program between February 2004 and January 2007 was performed. RESULTS: Sixteen patients received FEIBA for refractory postoperative bleeding. The majority (69%) received a single dose, either intraoperatively or postoperatively. The recipients of multiple doses were more likely to undergo operative reexploration. Blood product utilization and hourly chest tube output were decreased significantly following administration of FEIBA. Three deaths occurred (19%), two from multisystem organ failure and one from respiratory failure. Thrombotic events included the development of a clotted hemothorax in one patient and distal extremity ischemia in another. CONCLUSIONS: FEIBA administration is associated with decreased blood product utilization and chest tube output in patients with refractory postoperative bleeding.