Factor VIIa for Correction of Traumatic Coagulopathy

Abstract

FVIIa therapy lead to an immediate reduction in coagulopathic hemorrhage in most cases, accompanied by a significant improvement in laboratory measures. Application of FVIIa as a therapy of last resort makes the identification of equivalent control patients difficult. Use of FVIIa should be considered for any patient with coagulopathic hemorrhage in which surgically-accessible bleeding has been controlled. Prospective trials of FVIIa in patients with traumatic coagulopathy are strongly indicated, and should focus on appropriate patient selection and the dose and timing of therapy.

Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis: A randomized, controlled trial

“…The ability of rFVIIa to effect hemostasis in other clinical settings has also been demonstrated in case reports and clinical trials. [23][24][25][26] In a randomized, controlled trial investigating the safety and efficacy of rFVIIa in patients with upper gastrointestinal bleeding (UGIB) and cirrhosis, there was no significant effect of rFVIIa treatment on the number of 5-day failures in the total population. 8 However, a finding from posthoc analysis was that rFVIIa significantly reduced the number of 5-day failures and improved 24-hour bleeding control in the subgroup of Child-Pugh B and C patients with variceal bleeding, which were the patients with greater impairment of hemostatic parameters.…”

Pharmacotherapy of Massive Obstetric Bleedings as Alternative to Hysterectomy

“…(Aggarwal et al, 2004;Ahonen & Jokela, 2005;Ahonen et al, 2007;Boehlen et al, 2004;Bomken et al, 2009;Bouwmeester et al, 2003;Boyer-Neumann et al, 2003;Brueckner et. al., 2001;Dart et al, 2004;Dutton et al, 2004;Eikelboom et al, 2003;Franchini et al, 2007;Franchini et al, 2008;Hollnberger et al, 2005;Holub et al, 2005;Jansen et al, 2005;Jimenez-Yuste et al, 2000;Kale et al, 2004;Kretzschmar et al, 2003;Macphail et al, 2004;Martinowitz & Michaelson, 2005;Mayo et al, 2004;Merchant et al, 2004;Mittal & Watson, 2006;Moscardo et al, 2001;Mousa & Walkinshaw, 2001;Mousa & Alfirevic, 2003,2007Nowacka et al, 2005;Palomino et al, 2006;Pepas et al, 2006;Price et al, 2004;Segal et al, 2004;Shamsi et al, 2005;Shander et al, 2005;Sobieszczyk et al, 2002Sobieszczyk et al, , 2004Sokolic et al, 2002;Tanchev et al, 2005;Verre et al, 2006;Vincent et al, 2006;Welsh et al, 2008;…”

“…For the last decade, the use of rFVIIa, with more specified data about mechanisms of its action has been successfully approved «off-label» to stop other uncontrolled hemorrhages unassociated with haemophilia, to reduce the need for allogenic blood. They included intracranial hemorrhage, bleedings due to coumarin use, hepatic coagulopathy, major surgery and traumas (Aggarwal et al, 2004;Aldouri, 2002;Dutton al., 2004;Eikelboom et al, 2003;Franchini et al, 2007;Ghorashian & Hunt, 2004;Hedner, 2003;Mathew, 2004;Martinowitz et al, 2002;Martinowitz & Michaelson, 2005;Mayo et al, 2004;Mittal & Watson, 2006;O'Connell et al, 2003;Price et al, 2004;Roberts et al, 2004;Sobieszczyk & Breborowicz, 2004;Uhlmann & Eby, 2004;Vincent et al, 2006).…”

Management of Critical Bleeding in Trauma Patients: Between Recommendations and Reality

“…There were promising results when recombinant-activated factor VII (rFVIIa) came on the scene and evidences of its effectiveness in the treatment of uncontrolled bleeding led to many studies that examined its effect on critical bleeding in traumatic haemorrhage [44]. Animal models have shown that rFVIIa effectively decreases blood loss at trauma [45] and also increased evidence of its efficacy at trauma patients was found [46,47].…”

“…Therefore, its use in traumatic haemorrhage is rational. Despite "off-label" use of rFVIIa, it can be used in conditions of uncontrolled haemorrhage [44,58]. Use of rFVIIa should be by consensus between surgeon, intensivist and haematologist when the patient is at risk to die from uncontrolled bleeding due to coagulopathy.…”