Rapid warfarin reversal with factor VIIa in an elderly trauma patient with retroperitoneal hematoma

While mortality from trauma increases, there has been a decline in mortality from cardiovascular and cerebrovascular diseases which parallels advances in antithrombotic and anticoagulation therapy. Warfarin (coumadin) is the most common oral anticoagulant used for chronic anticoagulant therapy and most patients requiring such therapy are elderly (greater than 65 years old). The most common complication of warfarin use is adverse bleeding. It is becoming increasingly evident the population at highest risk for sustaining a complication related to anticoagulation is that group presenting with traumatic brain injury. Recent studies show that patients with other injury patterns do not appear to have significant differences post trauma, although the data about such outcomes is sparse. Significant bleeding from retroperitoneal hematomas is more often associated with major pelvic fractures from high energy blunt force mechanisms, and the blood loss may be tamponaded by the retroperitoneal structures if natural clotting mechanisms are intact. Recombinant Factor VIIa (FVIIa) can be used to reverse coagulopathy in patients on coumadin who sustain a traumatic injury.