title: A review of recombinant factor VII for refractory bleeding in nonhemophilic trauma patients.
abstract: BACKGROUND
  Recombinant factor VII (rFVII) is an attractive agent to control refractory, coagulopathic bleeding in patients following major surgery. The purpose of this review is to evaluate the published experiences of rFVII in adult, nonhemophilic, surgical and trauma patients.
  
  
  METHODS
  A computerized literature search was conducted to identify articles pertaining to rFVII use for refractory bleeding in adult, nonhemophilic, surgical patients. The selected articles were reviewed and the applicable data was analyzed.
  
  
  RESULTS
  A total of 117 patients were found in 8 case series and 24 case reports. Overall, rFVII was effective in restoring hemostasis in 99/117 (85%) patients with 76/99 (77%) surviving to hospital discharge. In trauma patients, hemostasis was achieved in 20/26 (77%) patients and 17/20 (85%) survived. There were 5 (4%) thromboembolic events observed in the 117 cases and much disparity was noted with the initial dose. Severe acidosis affected the activity of rFVII.
  
  
  CONCLUSIONS
  Recombinant factor VII is an effective therapeutic agent for achieving hemostasis in nonhemophilic surgical patients. Published clinical experiences, however, are limited to small case series and case reports.
authors.affiliation: Department of Pharmacy, Spectrum Health, Grand Rapids, MI 49503, USA. Jeffrey.barletta@spectrum-health.org
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Barletta
authors.forename: Christine L
authors.initials: CL
authors.lastname: Ahrens
authors.forename: James G
authors.initials: JG
authors.lastname: Tyburski
authors.forename: Robert F
authors.initials: RF
authors.lastname: Wilson
mesh_terms: D003362:Cost-Benefit Analysis; D016527:Drug Costs; D017850:Economics, Pharmaceutical; D017707:Erythrocyte Transfusion; D005167:Factor VII / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use*; D006470:Hemorrhage / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D006487:Hemostasis; D006801:Humans; D018579:Patient Selection; D012449:Safety; D016019:Survival Analysis; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications*
chemical_list: D005167:Factor VII