title: Futility Assessment of Recombinant Factor VII Activated for the Treatment of Hemorrhagic Shock Requiring Massive Transfusion.
abstract: OBJECTIVE
  Recombinant human factor VII activated (rFVIIa) is an adjuvant therapy in patients receiving massive transfusion for hemorrhagic shock. We compared patient characteristics and outcomes to determine futility criteria for the administration of rFVIIa in patients receiving massive transfusion for hemorrhagic shock.
  
  
  METHODS
  This was a retrospective cohort analysis of patients who received both massive transfusion and rFVIIa. Consecutive trauma patients were allocated to 1 of 2 cohorts: survivors and nonsurvivors.
  
  
  RESULTS
  Seventy-two subjects comprised the study: 27 were survivors and 45 were nonsurvivors. A univariate analysis revealed that nonsurvivors were older and had a more profound coagulopathy as measured by prothrombin time. A stepwise logistic regression revealed an increased odds of death in those patients who were older (odds ratio [OR], 1.048; 95% CI, 1.008 -1.091), had a higher admission prothrombin time (OR, 1.561; 95% CI, 1.152-2.116), and received more fresh frozen plasma (OR, 1.098; 95% CI 1.023-1.179). In addition we saw a protective effect with increased platelet administration (OR, 0.645; 95% CI, 0.446-0.932).
  
  
  CONCLUSIONS
  The use of rFVIIa for massive transfusion in middle-aged patients with moderate coagulopathy experiencing hemorrhagic shock may be considered futile. However, if rFVIIa is to be used as part of a massive transfusion protocol, adequate administration of platelets should be ensured.
authors.affiliation: Department of Pharmacy.
authors.forename: James C
authors.initials: JC
authors.lastname: McMillen
authors.affiliation: Department of Surgery.
authors.forename: Christy M
authors.initials: CM
authors.lastname: Lawson
authors.affiliation: Department of Clinical Pharmacy, The University of Tennessee Health Science Center, Collage of Pharmacy, Knoxville, Tennessee.
authors.forename: A
authors.initials: A
authors.lastname: Shaun Rowe
keywords: blood transfusion; coagulopathy; factor VIIa; futility; multiple trauma; plasma; platelets