From the Research
NovoSeven (recombinant factor VIIa) should be used with extreme caution in patients with macroscopic hematuria due to the significant risk of ureteral thrombi formation, and the recommended approach is to avoid NovoSeven if possible in these patients, or if absolutely necessary, use the lowest effective dose with close monitoring of urinary output and renal function. The use of NovoSeven in patients with macroscopic hematuria can lead to thrombus formation in the urinary collecting system, potentially causing ureteral obstruction, hydronephrosis, and renal damage 1. In patients with macroscopic hematuria, blood in the urinary tract provides a substrate for clot formation, and NovoSeven can accelerate this process.
The management of macroscopic hematuria involves a thorough history and physical to determine potential causes and assess risk factors for malignancy, with a risk of malignancy greater than 10% in patients with gross hematuria 2. The presence of macroscopic hematuria warrants prompt urologic referral, and patients with risk factors for genitourinary malignancy, macroscopic hematuria, or those in whom no cause is found, should be referred to a urological service for further investigation including cystoscopy 3.
If NovoSeven must be used, ensure adequate hydration, consider urinary catheterization for monitoring and irrigation if appropriate, and perform regular ultrasound assessments to detect early signs of obstruction. Alternative hemostatic agents with lower thrombotic potential should be considered first in patients with active urinary tract bleeding. The most recent study on hematuria recommends a thorough evaluation, including urine microscopy, culture, and imaging studies, to determine the underlying cause of hematuria 4.
In terms of the risk of ureteral thrombi with NovoSeven in the presence of macroscopic hematuria, the evidence suggests that the use of NovoSeven can increase the risk of thrombus formation, and therefore, it should be used with caution. The study by 1 highlights the importance of considering microscopic haematuria as a contraindication for tranexamic acid, which also has a risk of clot formation in the urinary tract.
Key considerations in the management of patients with macroscopic hematuria include:
- Avoiding the use of NovoSeven if possible
- Using the lowest effective dose of NovoSeven if necessary
- Close monitoring of urinary output and renal function
- Ensuring adequate hydration
- Considering urinary catheterization for monitoring and irrigation if appropriate
- Performing regular ultrasound assessments to detect early signs of obstruction
- Considering alternative hemostatic agents with lower thrombotic potential.