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Factor VIIa for intractable blood loss in trauma
  1. Jon Argall, Senior Clinical Fellow,
  2. Stewart Teece, Clinical Research Fellow,
  3. K Mackway-Jones
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

    Abstract

    A short cut review was carried out to establish whether factor VIIa is indicated in patients suffering intractable blood loss after trauma. Altogether 59 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by Jon Argall, Senior Clinical Fellow
 Checked by Stewart Teece, Clinical Research Fellow

    Clinical scenario

    A 29 year old man is brought into the resuscitation area having jumped out of a fourth floor window. He has abdominal and pelvic injuries but no chest, head, or limb injuries. He is bleeding intractably and the orthopaedic team and surgical team cannot agree on a plan of management. You suggest that operative management is required, but they would like to perform a CT scan before theatre to determine who will lead the surgery. Exasperated you wonder whether factor VIIa would help to stabilise the patient and reduce his requirement for transfusion.

    Three part question

    In [trauma patients with major blood loss and intractable bleeding requiring massive transfusion] does [recombinant factor VIIa] reduce [morbidity and mortalilty]?

    Search strategy

    Medline 1966–07/02 using the OVID interface. [exp Factor VII OR exp Factor VIIa OR (factor adj5 VII).af OR (factor adj5 VIIa).af OR rFVIIa.af] AND [exp hemorrhage OR hemorrhage.af OR exp haemorrhage.af OR bleeding.af. OR (blood adj5 loss).af] AND [exp “Wounds and Injuries” OR trauma.af OR injur$.af OR wound$.af] LIMIT to human AND English.

    Search outcome

    Altogether 59 papers were found of which two were relevant. The details are shown in table 8.

    Table 8

    Comment(s)

    More studies are needed.

    ▸ CLINICAL BOTTOM LINE

    Factor VIIa may have a role as a temporising adjunct to surgical haemostasis. Further research is needed.

    Report by Jon Argall, Senior Clinical Fellow
 Checked by Stewart Teece, Clinical Research Fellow

    References

    View Abstract

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