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Comparative Effectiveness of In-Hospital Use of Recombinant Factor VIIa for Off-Label Indications vs. Usual Care

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Overview of rFVIIa Use for Liver Transplantation

There were four RCTs (two of fair quality, two of poor quality) and one comparative observational study (fair quality) with 215 patients who received prophylactic rFVIIa at initiation of liver transplantation. This yielded low strength of evidence with fair applicability for prophylactic use in the population targeted—patients with cirrhosis of Child’s class B or C. There was no effect of rFVIIa use on mortality or thromboembolism relative to usual care. There was a trend across studies  toward reduced RBC transfusion requirements with rFVIIa use vs. usual care. Neither operating room time nor ICU length of stay  were reduced with rFVIIa use when compared to usual care. Current evidence of low strength is too limited to compare harms and benefits.