The role of thromboelastometry and recombinant factor VIIa in trauma.
OBJECTIVE
Recombinant factor VIIa (rFVIIa) and thromboelastography have acquired increasing importance in patients with severe bleeding and coagulopathy. This article reviews the current opinions regarding their use, with the purpose of clarifying the ambiguities that exist in dealing with trauma patients.


RESULTS
Recent evidence encourages the early use of rFVIIa and thromboelastography in the severe trauma patient with hemorrhagic shock, as a component of the damage control strategy. rFVIIa may decrease short-term mortality and the rate of required blood components during resuscitation, with no apparent increase in thromboembolic complications. Thromboelastometry enables better and earlier recognition of the coagulopathy accompanying such trauma patients. In patients with traumatic brain injury and coagulopathy, rFVIIa may delay or even halt the need for surgery, with no proven decrease in mortality. In those who needed urgent neurosurgical intervention, rFVIIa may rapidly correct the coagulopathy, enabling earlier and safer surgical intervention.


CONCLUSIONS
Thromboelastometry may guide the medical staff when and to whom rFVIIa could be administered. Evidence also encourages the use of rFVIIa in traumatic brain injury. More research is required to prove decreases in mortality using both thromboelastography and rFVIIa in trauma, with a focus on clear end points and goal-directed therapy.
Bartal
Carmi
C
The Medical-Surgical Intensive Care Unit, Critical Care Department, Soroka University Medical Center and Faculty for Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. carmibt@zahav.net.il
Yitzhak
Avraham
A
D001930:Brain Injuries / Q000097:blood / Q000188:drug therapy; D002985:Clinical Protocols; D000075202:Contraindications; D015942:Factor VIIa / Q000627:therapeutic use*; D017408:Guidelines as Topic; D006470:Hemorrhage / Q000097:blood* / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000097:blood / Q000188:drug therapy; D018579:Patient Selection; D011994:Recombinant Proteins / Q000627:therapeutic use; D013916:Thrombelastography; D014947:Wounds and Injuries / Q000097:blood* / Q000150:complications / Q000188:drug therapy
D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa