RT Journal
A1 Capozzi, James D.
A1 Rhodes, Rosamond
A1 Cornwall, Roger
T1 Bedside Rationing
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2002
FD July 1
VO 84
IS 7
SP 1279
OP 1281
DO 
UL http://dx.doi.org/
AB 
A fifty-five-year-old man with severe type-A hemophilia (factor-VIII
deficiency) and high-titer antibodies to factor VIII sustained an
intertrochanteric hip fracture. Open reduction and internal fixation
was performed uneventfully with intraoperative infusion of recombinant
activated factor VII (rFVIIa), a new and expensive product used
to treat factor-VIII deficient patients with antibodies to exogenous
factor VIII. On the second postoperative day, the rFVIIa was discontinued
and an activated prothrombin complex concentrate (aPCC), a less
expensive product, was given. Substantial bleeding ensued over the
next twenty-four hours, necessitating transfusion of six units of
packed red blood cells to maintain hemodynamic stability. The rFVIIa
was restarted, resulting in prompt control of the bleeding. This
medication was continued for the remainder of the postoperative
period, with adequate hemostasis. The cost for treatment with aPCC
is $10,400 per day. The cost for treatment with rFVIIa is $92,400
per day. This patient consumed $1.2 million worth of rFVIIa during
his hospital stay.