Recombinant activated coagulation factor VII and bleeding trauma patients.

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Hematology

Background:

• Recombinant activated coagulation factor VII (rFVIIa) is used for massive hemorrhage in trauma.
• While rFVIIa corrects coagulopathy and reduces transfusions, its impact on survival is unproven.
• This study investigates rFVIIa's effect on in-hospital survival in massively bleeding trauma patients.

Purpose of the Study:

• To determine the effect of rFVIIa on in-hospital survival in massively bleeding trauma patients.
• To analyze the association between rFVIIa administration and short-term (24-hour) and overall survival.

Main Methods:

• Retrospective cohort study (2000-2005) at a Level I trauma center.
• Inclusion criteria: trauma patients needing ≥8 units of packed red blood cells in 12 hours.
• Primary exposure: rFVIIa administration; Outcomes: 24-hour and in-hospital survival.

Main Results:

• 242 patients met criteria; 38 received rFVIIa.
• rFVIIa associated with improved 24-hour survival (OR 3.4) and a trend for overall survival (OR 2.5).
• 24-hour survivors had slower initial transfusion rates, higher platelets, and smaller base deficits.

Conclusions:

• rFVIIa may enhance early survival in massively bleeding trauma patients.
• Efficacy is questionable with extremely high transfusion rates, underscoring surgical hemorrhage control.
• Correction of acidosis and thrombocytopenia may be crucial for rFVIIa effectiveness; prospective studies are needed.