A reappraisal of plasma, prothrombin complex concentrates, and recombinant factor VIIa in patient blood management.
Plasma therapy and plasma products such as prothrombin complex concentrates (PCCs), and recombinant activated factor VII (rFVIIa) are used in the setting of massive or refractory hemorrhage. Their roles have evolved because of newly emerging options, variable availability, and heterogeneity in guidelines. These factors can be attributable to lack of evidence-based support for a defined role for plasma therapy, variability in coagulation factor content among PCCs, and uncertainty regarding safety and efficacy of rFVIIa in these settings. This review summarizes these issues and provides insight regarding use of these options in management of refractory or massive bleeding.
Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305-5626, USA. ltgoodno@stanford.edu
Lawrence Tim
LT
Goodnough
D001779:Blood Coagulation Factors / Q000627:therapeutic use*; D003422:Critical Care / Q000379:methods*; D015942:Factor VIIa / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced / Q000628:therapy*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D010949:Plasma; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use; D012720:Severity of Illness Index; D014859:Warfarin / Q000009:adverse effects
D001779:Blood Coagulation Factors; D006490:Hemostatics; D011994:Recombinant Proteins; C025667:prothrombin complex concentrates; D014859:Warfarin; C103587:recombinant FVIIa; D015942:Factor VIIa