Factor VIIa (recombinant) for acute traumatic hemorrhage.

PURPOSE: The use of factor VIIa (recombinant) for the treatment of acute traumatic hemorrhage is reviewed.
SUMMARY: Factor VIIa (recombinant) has received considerable attention as a hemostatic agent and is increasingly being used for the management of bleeding associated with a variety of conditions. Severely injured trauma patients with uncontrolled bleeding are at high risk for coagulopathy and may benefit from the administration of factor VIIa (recombinant). A literature review was conducted to identify original research in the form of randomized controlled trials investigating the use of factor VIIa (recombinant) for the treatment of traumatic hemorrhage. Due to the paucity of such trials, three retrospective evaluations and three large case series pertaining to this topic were also reviewed. Of the two randomized controlled trials, one found a reduction in red blood cell (RBC) transfusion requirements in patients with blunt traumatic hemorrhage after the administration of factor VIIa (recombinant). This reduction in RBC requirements was not found in the study conducted with patients with penetrating trauma. These trials were not powered to show a mortality difference, and the effect of factor VIIa (recombinant) on survival in blunt and penetrating traumatic hemorrhage is unknown. Ongoing clinical trials may answer questions regarding its effect on mortality and other clinically important outcomes.
CONCLUSION: Factor VIIa (recombinant) reduces RBC transfusion requirements in patients with blunt traumatic hemorrhage, and its effect on mortality is currently being investigated. Adjunctive use of factor VIIa (recombinant) should be considered only after other treatment modalities have been optimized.