Treatment of severe coagulopathy after gunshot injury to the head using recombinant activated factor VII.
OBJECTIVE
Patients with severe penetrating head injury often have a coagulopathy that is difficult to correct. In this report, we describe 3 such patients who were treated with activated factor VII (FVIIa) to stop ongoing hemorrhage that was refractory to conventional treatment.


METHODS
We treated 3 patients with severe head injury secondary to gunshot wounds to the head. All 3 patients had ongoing bleeding secondary to a severe consumptive coagulopathy that was refractory to treatment with fresh frozen plasma, platelets, and cryoprecipitate. Recombinant FVIIa was then administered to achieve hemostasis.


RESULTS
Administration of FVIIa (90-120 microg/kg) was successful in rapidly achieving hemostasis and correcting abnormal laboratory parameters indicative of coagulopathy in all patients. Although all 3 patients died, control of bleeding made organ donation possible in 2 patients.


CONCLUSIONS
In patients with a severe head injury and coagulopathy, use of FVIIa may help in correction of coagulopathy and decrease transfusion requirements. In patients where ongoing bleeding precludes the declaration of brain death, the use of this agent might help in achieving hemodynamic stability and preserve the possibility of organ donation. The ethical implications of using FVIIa in this situation are discussed.
Aiyagari
Venkatesh
V
Department of Neurology and Rehabilitation, University of Illinois, Chicago, 60612, USA. aiyagari@uic.edu
Menendez
Jose A
JA
Diringer
Michael N
MN
D000328:Adult; D006259:Craniocerebral Trauma / Q000150:complications*; D004211:Disseminated Intravascular Coagulation / Q000188:drug therapy*; D015942:Factor VIIa / Q000627:therapeutic use*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D017211:Treatment Failure; D014948:Wounds, Gunshot / Q000150:complications*
D015942:Factor VIIa