Tuesday September 02, 2008
Alternatives to Fresh Frozen Plasma in Coagulopathy patients

Coagulopathy is generally treated with fresh frozen plasma in injured patients with coagulopathy. High dose recombinant factor VIIa has been used off label to treat severe coagulopathy following trauma. Deborah Stein from University of Maryland studied the use of Low-dose recombinant factor VIIa for trauma patients with coagulopathy.

Study design: Retrospective with 81 patients receiving 84 doses of low dose factor VIIa. Etiology of the coagulopathy patient in study population included:

• Traumatic brain injury (40%),
• warfarin use (22%)
• Cirrhosis (13%)

Results:

• Mean prothrombin time (PT) fell from 17s (+/-3.2) to 10.6 (+/- 1.4).
• All patients had a good clinical response with no bleeding complications.
• Utilization of packed red blood cells and fresh frozen plasma were significantly less in the 24 h after FVIIa administration as compared to the 24 h prior.
• Subsequent thromboembolic events were observed in 12 of the 81 patients (15%) and included; CVA (6), mesenteric thrombosis (2), myocardial infarction (1), pulmonary embolism/deep venous thrombosis (2), and atrial thrombus (1). Only four of these events were thought to be related to the FVIIa administration, with two of the four contributing to a lethal outcome.

Conclusions: The low dose (1.2mg) Factor VIIa rapidly and effectively treat mild to moderate coagulopathy following injury, and is felt to be cost effective.

Reference: Click to get abstract/article

Stein DM, Dutton RP, Hess JR, Scalea TM. Low-dose recombinant factor VIIa for trauma patients with coagulopathy. Injury 2008; 39 (9):1054-1061