title: Recombinant factor VIIa as last-resort treatment of desperate haemorrhage.
abstract: BACKGROUND
  Studies are inconclusive regarding clinical outcomes after administration of recombinant activated coagulation factor VII (rFVIIa) during severe haemorrhage. The circumstances encountered during desperate haemorrhage make it difficult to include the most critically ill patients that could possibly benefit the most from such treatment into randomized controlled trials. We report our experience with rFVIIa as last-resort treatment of desperate haemorrhage when all standard treatment has failed.
  
  
  METHODS
  Hospital charts of all consecutive patients treated with rFVIIa for desperate non-haemophilic bleeding over a 10-year period at the single institution administering rFVIIa were surveyed for treatment indications, clinical outcome, transfusion need and coagulation profiles.
  
  
  RESULTS
  Fifty-five rFVIIa treatment occasions of desperate bleeding were identified in 54 patients (median age 54 years). A single rFVIIa dose was used in 86%, and haemorrhage was considered effectively contained by immediate clinical response on 81% of occasions. Overall, 38 patients (71%) survived for over 30 days. Two thromboembolic events occurred (3.6%). The 24-h mortality in 45 rFVIIa immediate clinical responders and 10 non-responders was 2% and 50%, respectively (P = 0.0004), and the 30-day mortality was 25% and 60%, respectively (P = 0.05). Blood product use decreased with rFVIIa (P < 0.01) as did the prothrombin time (20.0-13.3 s, P < 0.0001).
  
  
  CONCLUSIONS
  The majority of unselected consecutive patients receiving rFVIIa as last-resort treatment for desperate haemorrhage were considered to have immediate clinical response as well as reduced transfusion requirements and correction of coagulation parameters. An immediate clinical response to rFVIIa may possibly be predictive of survival.
authors.affiliation: Division of Internal Medicine, Landspitali-University Hospital, Reykjavik, Iceland.
authors.forename: R
authors.initials: R
authors.lastname: Palmason
authors.forename: B
authors.initials: B
authors.lastname: Vidarsson
authors.forename: K
authors.initials: K
authors.lastname: Sigvaldason
authors.forename: J P
authors.initials: JP
authors.lastname: Ingimarsson
authors.forename: T
authors.initials: T
authors.lastname: Gudbjartsson
authors.forename: G H
authors.initials: GH
authors.lastname: Sigurdsson
authors.forename: P T
authors.initials: PT
authors.lastname: Onundarson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D004632:Emergency Medical Services; D015199:Extracorporeal Membrane Oxygenation; D015942:Factor VIIa / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007055:Iceland; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011517:Prothrombin Time; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa