Factor VIIa order form (fax completed form to 4-3137)
Note: Factor VIIa (NovoSeven) is licensed for the treatment of hemophilia A and B inhibitor patients since 1999. In off label use it has been reported to limit perioperative bleeding, and to limit the intracerebral hemorrhage including that in warfarin patients. There are increasing reports of arterial and venous thromboembolism with an incidence in one report of 7%, roughly one third of which were fatal. Consider the risk: benefit ratio when deciding on Factor VIIa use.
Warfarin Patient’s INR / Factor VIIa doseINR <3 / Factor VIIa not indicated, use FFP
INR 3-5 / Factor VIIa 30-40 micrograms/kg
INR >5 / Factor VIIa 30-40 micrograms/kg plus FFP 5-10 cc/kg (3-5 U FFP)
Note: submit new blood specimen and order Blood Type to obtain FFP
Other patients, Hemorrhage location: / Intracranial hemorrhage
Other hemorrhage site(s): GI, Retroperitoneal etc.
Traumatic hemorrhage
Other______
F VIIa 30-40 micrograms/kg, plus FFP if blood loss approaches >0.5 blood volume
Factor VIIa order: / ______Patient weight in kg4 ______Patient’s INR5
______Factor VIIa micrograms being ordered (in multiples of 1200)3
______
Physician signature, ID#, date, time
Patient Location: / Factor VIIa unit(s) will be picked up personally
Please tube the Factor VIIa to tube#______/ ______Unit name
- Repeat the patient’s coagulation profile no sooner than one hour after Factor VIIa and FFP have been administered.
- In major hemorrhage situations, a second dose of VIIa may be needed to control bleeding.
- SBUH carries 1200 & 2400 microgram vials. After calculating the patient’s dose, round up to the nearest complete vial.
- In morbidly obese patients, consider calculating the dose for a patient 20% above the ideal body weight for the patient’s age and height.
- Patient’s INR must have been measured within 6 hours of Factor VIIa order time.