[Hemostatic treatment for intractable traumatic hemorrhage using fibrinogen concentrates and recombinant activated...

A male patient in his thirties presented to the emergency room of our hospital after a traffic injury. He was in hemorrhagic shock and was diagnosed with a pelvic bone fracture by computed tomography. Despite a massive transfusion of red cells, platelets, and fresh frozen plasma, the bleeding was determined to be continuous because his blood pressure remained unstable and his platelet count and coagulation parameters did not improve. Because ordinary replacement therapy was ineffective, the patient was infused with fibrinogen concentrates and recombinant activated factor VII (rFVIIa), although these are off-label indications in Japan. He recovered from the hemorrhagic shock immediately after the infusion. Although there have been several reports on the management of intractable hemorrhage secondary to severe trauma using rFVIIa, we have experienced few such cases. This patient was rescued by hemostatic treatment with fibrinogen concentrates and rFVIIa.