The use of recombinant factor VIIa (NovoSeven) for treatment of active or impending bleeding in brain injury: broadening the indications.
We report three patients with severe traumatic brain injury, both open and closed, who were treated with recombinant activated factor VII. This treatment was given in a desperate, last-ditch effort to save the life of patient 1, as a preventive or early treatment of a developing hematoma in patient 2, and as treatment of a threatening hematoma in patient 3. One of the three patients survived. During the past few years we have broadened the indications for recombinant activated factor VII and started using it as a preventive measure rather than as a "last line of defense." However, the potential complications of disseminated intravascular coagulation and thrombotic events, as well as the cost-effectiveness in view of the available evidence-based medicine, should be considered.
Yusim
Yakov
Y
Department of Anesthesiology, Sheba Medical Center, Tel-Hashomer 52621, Israel.
Perel
Azriel
A
Berkenstadt
Haim
H
Attia
Moshe
M
Knoller
Nachshon
N
Sidi
Avner
A
D000328:Adult; D000368:Aged; D020201:Brain Hemorrhage, Traumatic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000191:economics; D002648:Child; D004211:Disseminated Intravascular Coagulation / Q000139:chemically induced / Q000191:economics; D005167:Factor VII / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D015942:Factor VIIa; D006408:Hematoma, Subdural / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control*; D006801:Humans; D008297:Male; D011859:Radiography; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D013927:Thrombosis / Q000139:chemically induced / Q000191:economics
D011994:Recombinant Proteins; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa