[Activated recombinant factor VII (Novoseven) in multiple trauma patients: an outcome analysis]

In multiple trauma patient the bleeding is a major cause of death and it is caused by vascular injury or post-traumatic coagulopathy. Regardless of etiology, management of massive bleeding requires immediate surgery to stop bleeding with simultaneous stabilization of hemostasis and maintenance of normovolemia. The objective was to evaluate the efficacity and safety of recombinant activated factor VII in patients with massive posttraumatic hemorrhage after failure of conventional methods to control bleeding (surgical haemostasis, volemic resuscitation, transfusions, rewarming).

34 multiple trauma patients with severe hemorrhage requiring > 10 transfusion units of packed red cells received recombinant activated factor VII. Postdrug transfusion requirements were assessed (red packed cells, fresh frozen plasma, platelet concentrations and cryoprecipitate), and mortality was compared with predicted outcomes, using Injury Severity Score, Revised Trauma Score and Trauma Score-Injury Severity Score. We also noted the incidence of adverse effects, mostly thromboembolic events. We use a special design chart to follow the patients who received rFVIIa.

We have the following results: the mortality rate was reduced (without statistical relevance), the coagulation times also reduced--aPTT decreases from 76 s to 38.5 (p = 0.000), PT from 23 s to 18 s (p = 0.000), transfusion requirements decrease- RPCs from 11.5 units to 3 units (p = 0.000), FFP from 7.5 units to 2 units (p = 0.000). We analysed the cases with adverse effects but we didn't find a direct cause- effect explication.

The rFVIIa is efficient in post-trauma-tic bleeding (decrease transfusion requirements, normalized coagulation times), reduce mortality rate.