Efficacy and Safety Analysis of Recombinant Factor VIIa in Severe Post-partum Hemorrhage

• DOI: 10.20944/preprints202403.0153.v1
• Publication Date: 2024-03-06T02:50:00Z
• Authors: Camila Caram-Deelder; Hellen McKinnon E...; Jarmila A Zdanowicz; Thomas Van den Akker; Camilla Birkegård; Jan Blatný; Johanna Van der Bom; Giuseppe Colucci; Derek Van Duuren; Nan Van Geloven; Dacia Henriquez; Marian Knight; Lars Korsholm; Andrea Landorph; Géraldine Lavigne...; Zoe K McQuilten; Daniel Surbek; Cameron Wellard; Erica M Wood; Frederic J Mercier
• Keywords: thromboembolic events; post-partum hemorrhage; maternal mortality; pregnancy complications; therapeutic use; coagulants; obstetric; 610 Medicine & health; hematologic; delivery; recombinant activated factor VII; Article

Background: Despite a range of available treatments, there is a remaining unmet need for patients with severe post-partum hemorrhage (sPPH). Objective: This manuscript evaluated efficacy and safety of recombinant activated factor VIIa (rFVIIa) in sPPH management. Methods: An open-label, multi-center, randomized controlled trial (RCT; NCT00370877) and four observational studies (OS; OS-1 [NCT04723979], OS-2, OS-3 and OS-4) were analyzed regarding efficacy (need for subsequent invasive procedures, including uterine compression sutures, uterine or iliac artery ligation, arterial embolization or hysterectomy) and safety (incidence of thromboembolic events [TE] and maternal mortality) of rFVIIa for sPPH. The RCT, and OS-1 and OS-2, included a control group of women who did not receive rFVIIa (with propensity score-matching used in OS-1 and OS-2), whereas OS-3 and OS-4 provided descriptive data for rFVIIa exposed women only. Results: A total of 446 women exposed to rFVIIa and 1,717 non-exposed controls were included. In the RCT, fewer rFVIIa exposed women (50% [21/42]) had an invasive procedure versus non-exposed women (91% [38/42]; odds ratio 0.11, 95% confidence interval 0.03–0.35). In OS-1, more rFVIIa exposed women (58% [22/38]) had an invasive procedure versus non-exposed women (35% [13.3/38]; odds ratio 2.46, 95% confidence interval 1.06–5.99). In OS-2, 17% (3/18) of rFVIIa exposed women and 32% (5.6/17.8) of non-exposed women had an invasive procedure (odds ratio 0.33, 95% confidence interval 0.03–1.75). Across all included women, TEs occurred in 1.5% (0.2% arterial and 1.2% venous) of rFVIIa exposed women and 1.6% (0.2% arterial and 1.4% venous) of non-exposed women with available data. Conclusions: The positive treatment effect of rFVIIa in the RCT was not confirmed in the OS. However, the safety analysis did not show any increased incidence of TEs with rFVIIa treatment.