The use of recombinant activated factor VIIa in coagulopathic traumatic brain injuries requiring emergent craniotomy: is it beneficial?
OBJECTIVE
The role of recombinant activated factor VII (rFVIIa) in traumatic brain injury (TBI) has not been well established. This study evaluates the outcomes of using rFVIIa as first-line therapy in patients with a severe TBI requiring emergent craniotomy that are coagulopathic.


METHODS
The authors retrospectively reviewed patients admitted between 2003 and 2006 to a Level I trauma center with a severe TBI requiring an emergency craniotomy. Eighteen patients with coagulopathy that was corrected using rFVIIa were identified. Variables evaluated included age, injury severity score, head abbreviated injury score, Glasgow Coma Scale score, international normalized ratio, time to operation, operative procedure, thromboembolic events, and death.


RESULTS
The cohort consisted of 18 patients, predominantly male (55.6%) with a mean age of 80.5 years. The most common mechanism of injury was a fall. Coagulopathy was due to premorbid anticoagulants in 50% of the cohort. Time from admission to operation was 130 minutes. Coagulopathy reversal was complete in all 18 cases (100%). A high mortality rate (55.6%) was attributed to a high incidence of withdrawal of care (50%). The incidence of thromboembolic events was low (5.6%). Survivors, when compared with nonsurvivors, had a > 3-fold increase in postoperative Glasgow Coma Scale score for similar preoperative scores. A good functional outcome was achieved in 75% of survivors with a mean follow-up period of 4.2 months.


CONCLUSIONS
The use of rFVIIa in the correction of coagulopathy in patients having sustained severe TBI requiring emergency craniotomy appears to be safe and effective even among the elderly. This allows a shorter transit time to craniotomy. Its effects on mortality and long-term neurological outcome requires further investigation prospectively.
Department of Surgery, University of Pennsylvania Health System, Trauma/Critica Division, St. Luke's Hosptial, USA. mcquayn@slhn.org
Nathaniel
N
McQuay
James
J
Cipolla
Eleanor Z
EZ
Franges
Gregory E
GE
Thompson
D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation / Q000187:drug effects / Q000502:physiology*; D001930:Brain Injuries / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery*; D003029:Coagulants / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D015331:Cohort Studies; D003399:Craniotomy / Q000379:methods*; D015942:Factor VIIa / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D011994:Recombinant Proteins / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D016896:Treatment Outcome
D003029:Coagulants; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa