Trauma, transfusions, and use of recombinant factor VIIa: A multicenter case registry report of 380 patients from the Western Trauma Association.
BACKGROUND
This study describes the current use of recombinant activated factor VII (rFVIIa) for hemorrhage after trauma in the United States. We hypothesized that we could describe the setting in which rFVIIa would be most successful in arresting hemorrhage after injury.


METHODS
This case registry study of patients with traumatic injuries at risk for death from hemorrhage at Level I and II trauma centers in the United States analyzed the administration of rFVIIa from admission to death from hemorrhage. Secondary outcomes measures of interest were the use of blood products, days in the ICU, organ failure, and thrombotic complications.


RESULTS
Three hundred and eighty injured patients who received rFVIIa as an adjunct for hemorrhage control were included in this analysis. The mean time from admission to administration of rFVIIa was 4.6 hours, with an average transfusion of 18 U blood before administration (range 0 to 99 U). Death from hemorrhage rate was 30%. Predictors of a poor response to rFVIIa were a pH <7.2 (p < 0.0001), a platelet count <100,000 (p = 0.046), and blood pressure ≤90 mmHg (p < 0.0001) at the time of administration.


CONCLUSIONS
Based on this case registry review, the precise role of rFVIIa in traumatic hemorrhage is unclear. Surgeons choosing to use this drug as an adjunctive measure to reverse coagulopathy are advised to first correct shock, acidosis, and thrombocytopenia.
Department of Surgery, University of California, San Francisco, USA. pknkudson@sfghsurg.ucsf.edu
M Margaret
MM
Knudson
Mitchell J
MJ
Cohen
Rosemary
R
Reidy
Sebastian
S
Jaeger
Peter
P
Bacchetti
Chengshi
C
Jin
Charles E
CE
Wade
John B
JB
Holcomb
D000328:Adult; D015942:Factor VIIa / Q000627:therapeutic use*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D019106:Postoperative Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012042:Registries; D012773:Shock, Surgical / Q000517:prevention & control; D020246:Venous Thrombosis / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality / Q000601:surgery*; D055815:Young Adult
D006490:Hemostatics; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa