Real World Experience with Use of Coagulation Factor VIIa at an Academic Medical Center

Authors: George, AR; Sylvester, KW; Kanaan, DM; Reddy, P; Fanikos, JR; Connors, JM; Connell, NT

Affiliations: Department of Pharmacy, Henry Ford Hospital, Detroit, MI, USA. Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA USA. Center for Drug Policy, Mass General Brigham, Somerville, MA, USA. Vasculearn Network, Wakefield, MA, USA. Department of Hematology, Dana-Farber Cancer Institute, Boston, MA, USA.

Publication: Clinical and applied thrombosis/hemostasis; 2025; 31. 10760296251405425

ABSTRACT: BACKGROUND Eptacog alfa and eptacog beta are recombinant factors VIIa (rFVIIa) agents approved for use in hemophilia A or B with inhibitors. Our institution converted from eptacog alfa to eptacog beta as the preferred rFVIIa product. The objective of this medication use evaluation was to review the utilization of both agents and cost savings associated with the conversion. METHODS We performed a retrospective chart review for all eptacog alfa and beta administrations from October 2023 through September 2024. We evaluated product selection and dosing as well as the occurrence of thrombosis, new bleeding events, or existing bleeding that required therapy escalation. Cost savings were estimated using wholesale acquisition costs. RESULTS There were 17 patients that required 27 admissions for rFVIIa (eptacog alfa: 3, 11.1% and eptacog beta: 21, 77.8%). Three administrations (11.1%) utilized both agents. Indications included bleeding in hemophilia patients (12, 44.4%), followed by peri-procedural management (9, 33.3%), cardiac surgery (3, 11.1%), and anticoagulation reversal for life-threatening bleeding (3, 11.1%). There were 21 administrations in which eptacog beta was exclusively used (bleeding in hemophilia A (9, 33.3%), peri-procedural management (7, 25.9%), cardiac surgery (2, 7.4%), and anticoagulation reversal (3, 11.1%)). There were no thrombotic events. There were 5 patients (18.5%) who required rFVIIa dose escalation and two (7.4%) who required re-initiation of rFVIIa. Cost avoidance was estimated at $554,400 over a 12-month period. CONCLUSION We treated a small cohort of patients with eptacog beta without adverse outcomes. Other hospitals might evaluate their rFVIIa use and consider opportunities for substitution.