TY - JOUR
T1 - Treatment of severe coagulopathy after gunshot injury to the head using recombinant activated factor VII
AU - Aiyagari, Venkatesh
AU - Menendez, Jose A.
AU - Diringer, Michael N.
N1 - Funding Information:
This work was supported by grants from the American Heart Association (Dallas, TX) (grant 0360008Z) and the National Institutes of Health (Bethesda, MD) (grant 2 P01 NS35966-06). Dr Michael Diringer receives financial compensation for speaking and for serving on the Steering Committee of a trial sponsored by Novo Nordisk, the manufacturer of NovoSeven (recombinant FVIIa). The authors thank Ron Gegg, RN, BSN, CPTC; and Resa Osterholt, RN, from Mid-America Transplant Services.
PY - 2005/6
Y1 - 2005/6
N2 - Purpose: Patients with severe penetrating head injury often have a coagulopathy that is difficult to correct. In this report, we describe 3 such patients who were treated with activated factor VII (FVIIa) to stop ongoing hemorrhage that was refractory to conventional treatment. Subjects and Methods: We treated 3 patients with severe head injury secondary to gunshot wounds to the head. All 3 patients had ongoing bleeding secondary to a severe consumptive coagulopathy that was refractory to treatment with fresh frozen plasma, platelets, and cryoprecipitate. Recombinant FVIIa was then administered to achieve hemostasis. Results: Administration of FVIIa (90-120 μg/kg) was successful in rapidly achieving hemostasis and correcting abnormal laboratory parameters indicative of coagulopathy in all patients. Although all 3 patients died, control of bleeding made organ donation possible in 2 patients. Conclusion: In patients with a severe head injury and coagulopathy, use of FVIIa may help in correction of coagulopathy and decrease transfusion requirements. In patients where ongoing bleeding precludes the declaration of brain death, the use of this agent might help in achieving hemodynamic stability and preserve the possibility of organ donation. The ethical implications of using FVIIa in this situation are discussed.
AB - Purpose: Patients with severe penetrating head injury often have a coagulopathy that is difficult to correct. In this report, we describe 3 such patients who were treated with activated factor VII (FVIIa) to stop ongoing hemorrhage that was refractory to conventional treatment. Subjects and Methods: We treated 3 patients with severe head injury secondary to gunshot wounds to the head. All 3 patients had ongoing bleeding secondary to a severe consumptive coagulopathy that was refractory to treatment with fresh frozen plasma, platelets, and cryoprecipitate. Recombinant FVIIa was then administered to achieve hemostasis. Results: Administration of FVIIa (90-120 μg/kg) was successful in rapidly achieving hemostasis and correcting abnormal laboratory parameters indicative of coagulopathy in all patients. Although all 3 patients died, control of bleeding made organ donation possible in 2 patients. Conclusion: In patients with a severe head injury and coagulopathy, use of FVIIa may help in correction of coagulopathy and decrease transfusion requirements. In patients where ongoing bleeding precludes the declaration of brain death, the use of this agent might help in achieving hemodynamic stability and preserve the possibility of organ donation. The ethical implications of using FVIIa in this situation are discussed.
KW - Coagulopathy
KW - Factor VII
KW - Head injury
UR - http://www.scopus.com/inward/record.url?scp=24044515511&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2005.02.004
DO - 10.1016/j.jcrc.2005.02.004
M3 - Article
C2 - 16139160
AN - SCOPUS:24044515511
SN - 0883-9441
VL - 20
SP - 176
EP - 179
JO - Journal of Critical Care
JF - Journal of Critical Care
IS - 2
ER -