Factor eight inhibitor bypass agent (FEIBA) is a plasma derived procoagulant that contains primarily inactivated factors II (prothrombin), IX, and X. Additionally, it contains activated factor VII. FEIBA controls bleeding by facilitating the generation of thrombin through the prothrombinase complex.
FEIBA has been FDA approved for use in patients with hemophilia A and B with inhibitors to control/prevent bleeding and as part of perioperative management. Inhibitors are antibodies against clotting factors that these patients often receive throughout their lives in addition to what they produce. The cardiothoracic surgeons and anesthesiologists often reach a consensus to use FEIBA off-label in patients at high risk for bleeding, and anecdotally, I’ve had pretty good success with it using ~500 units.
As with all procoagulants, one must also consider the risk of thrombosis! The recommendation is NOT to use FEIBA in tandem with other agents like antifibrinolytics (tranexamic acid, aminocaproic acid, etc.)
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Soon enough ROTEM/TEG guided hemorrhage resuscitation should be included in guidelines alongside with cryoprecipitate, FFP and other therapies.
Thanks for the insight.
I agree, but just like many diagnostic modalities in medicine, it’s just a tool. I’ve often times had normal TEGs in the context of severe coagulopathy. The information is useful in guiding appropriate transfusion though!