The Potential Use of Recombinant Activated Factor VII in Trauma and Surgery

Abstract

It is possible that recombinant activated factor VII (rFVIIa) could revolutionise the medical and surgical management of haemorrhage following trauma and surgery due to its ease of administration and mechanism of action. This article reviews the evidence for the use of rFVIIa as a pro-coagulant, its mechanism of action, safety and recent research into its use in blunt and penetrating trauma and haemorrhage. The potential role of rFVIIa, both in the pre-hospital environment and in the emergency room or operating theatre, is discussed. Administration of rFVIIa at the roadside, on the battlefield or in a trauma centre may have significant potential implications, especially for the paramedical and surgical teams and even for strategic planners. Finally, the areas where further research is needed to provide objective evidence of its efficacy are elaborated. The potential thromboembolic complications of systemic administration of rFVIIa need to be carefully monitored but the high cost of this drug is likely to be the limiting factor in its widespread use.

A Single Dose of Recombinant Activated Factor VII (NovoSeven®) Did Not Impair the Function of the Coronary Artery Bypass Grafts – Successful Treatment of Critical Bleeding after Cardiac Surgery in Two Cases

“…In conclusion, rFVIIa may provide an opportunity for an effective and well tolerated treatment for serious bleeding episodes both during and after cardiac surgery. Obviously, rFVIIa represents a novel hemostatic agent that has the potential to reduce hemorrhage and subsequently perioperative blood loss and thus possibly increases survival rates by inducing coagulation at the site of vascular injury in patients with or without preoperative coagulation disorders [3,13]. More randomized, placebo-controlled, clinical trials are needed before definitive conclusions can be made about safety and the exact role of this new drug in surgical patients.…”

“…Activation of factor X independently of the tissue factor pathway leads to a substantial increase in thrombin generation at the platelet surface. As tissue factor or activated platelets are required, it is assumed that rFVIIa will produce a local effect [3] without systemic activation of coagulation. Thus rFVIIa represents a novel hemostatic agent that may exert the potential to reduce hemorrhage and perioperative blood loss.…”

The Role of Alternative Splicing in Breast Cancer Progression

“…The military surgeon has limited resources and the potential for being overwhelmed by many casualties, and as a result, FVIIa may make an important contribution to combat casualty care (Sapsford, 2004). FVIIa may have a damage control role, quickly arresting blood loss until the casualty can be evacuated to a higher-echelon hospital for more definitive care.…”

“…FVIIa promotes coagulation only at the site of the traumatic injury, and has other advantages that lend themselves to battlefield trauma, such as a rapid onset, short half-life (Hedner & Erhardtsen, 2002), and ease of administration (Sapsford, 2004). However, there are potential drawbacks to using FVIIa that should be considered, including complications such as unwanted thrombosis (O'Connell, Wood, Wise, Lozier, & Braun, 2006), and the expense of FVIIa.…”

Use of recombinant factor VIIA for control of combat-related haemorrhage

“…Recombinant rFVIIa promotes coagulation at the site of the injury, and has other advantages that lend themselves to battlefield trauma, such as a rapid onset, short half-life6 and ease of administration 7. However, there may be potential drawbacks to using rFVIIa that should be considered, including complications such as unwanted thrombosis,8 and the considerable expense of rFVIIa 9…”