Advantage of using a recombinant activated factor VII in traumatic haemorrhagic shock: The Bordeaux experience

Abstract

Introduction:Several series of patient studies have been published on the use of rFVIIa in traumatic haemorrhagic shock, although to date no international recommendations have been produced. France does not currently recognise traumatic haemorrhagic shock as an appropriate indication for the use of rFVIIa.Materials and methods:In this retrospective study, we present our experience in the use of rFVIIa in traumatic haemorrhagic shock.Results:Twenty-seven patients treated with rFVIIa after a traumatic injury between May 2005 and December 2008 were included. Average age was 46 years old. Eighty per cent of patients were polytransfused. Mortality rate was 33%. Adjusted mortality rate, using the Boffard study criteria, was 8.3%. We observed significant differences between the group of patients who died and the group of survivors in pH, PT, Hb, ionised calcaemia, temperature and platelet count. We observed significant differences between the successful rFVIIa group and the failed rFVIIa group in pH, Hb, platelet count and ionised calcaemia. Ten patients had an rFVIIa injection only and 17 patients had an rFVIIa injection combined with a mechanical procedure to stop the bleeding. Two patients presented with thromboembolic complications. We observed a tendency to recommend an rFVIIa injection before radical treatment is applied.Conclusion:It seems to us legitimate to recommend earlier use of rFVIIa in cases of traumatic haemorrhagic shock in the context of haematological damage control combined with the use of an algorithm to predict the risk involved in polytransfusion and a more aggressive transfusion strategy.

Massive Posttraumatic Bleeding: Epidemiology, Causes, Clinical Features, and Therapeutic Management

“…109 At variance with these studies, Morel et al treated 27 patients with rFVIIa after a traumatic injury and observed significant differences between the successful and the failed rFVIIa group in pH, hemoglobin, platelet count, and ionized calcemia, which finally led the authors to legitimate the earlier use of rFVIIa in cases of traumatic hemorrhagic shock in the context of hematologic damage control along with a specific risk algorithm. 110 A net benefit in favor of rFVIIa treatment to improve clinical outcomes and reduce mortality rate, transfusion and hospital stay costs, and transfusion requirements has also been reported by Koh et al in 54 patients with life-threatening hemorrhage due to multiple traumas. 111 More recently, Simpson et al searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EM-BASE, and other medical databases to retrieve randomized controlled trials comparing rFVIIa with placebo, or one dose of rFVIIa with another, in any patient population except hemophilia.…”