Recombinant Activated Factor VII: An Addition to Replacement Therapy in Trauma Patients with Uncontrolled Massive Bleeding
Abstract
Introduction: Trauma patients tend to have multiple sites of bleeding, sometimes in surgically inaccessible areas of the pelvis and retroperitoneum or in an organ that is difficult to control or repair such as the liver. Massive transfusion will lead to various complications of dilutional coagulopathy, acidosis and hypothermia, which will slow the enzymatic reactions of the coagulation cascade and impair platelet function. Recently, several studies reported the effectiveness of recombinant activated factor VII (rFVIIa) in restoring hemostasis in patients with massive bleeding related to trauma and surgery. Here, we report the use of rFVIIa in addition to blood component therapy to control massive bleeding in patients with trauma.
Materials and Methods: Recombinant activated factor VII (rFVIIa) at the initial dose of 100 µg/kg followed by 40 µg/kg at 4-6 hour interval for 24-48 hour was given as a rescue therapy to 8 males with trauma exhibiting massive bleeding unresponsive to surgical intervention and replacement therapy. Their median age was 24 years old. Causes of trauma included gun shot (n =1), multiple stabs (n = 3) and motorcycle accident (n= 4). Each patient sustained 2-5 injured sites involving the chest (n= 5), liver (n = 3), artery and vein (n = 6) and one each at the heart, brain, spleen and kidney. Five patients underwent simultaneously exploratory laparotomy and chest exploration (n = 4), and craniotomy and thigh exploration (n= 1). The remaining 3 patients underwent neck, thigh and chest explorations.
Results: Two patients died and 6 patients survived. No thrombotic complication was detected.
Conclusions: Our small series of patients with trauma suggested the potential benefit of rFVIla as a rescue therapy to control unresponsive massive bleeding.
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