Factor VIIa for correction of traumatic coagulopathy

Richard P. Dutton, Maureen McCunn, Mary Hyder, Matthew D'Angelo, James O'Connor, John R. Hess, Thomas M. Scalea, Michael J. Schurr, Tetsuo Yukioka, John T Owings, John B. Holcomb, J. David Hoyt, John A. Morris, George Velmahos, Martin Schreiber

Research output: Contribution to journalArticle

255 Citations (Scopus)

Abstract

Introduction: Activated factor VIIa (FVIIa) was developed to treat hemophiliacs with high-titer antibodies to factor VIII. FVIIa initiates thrombin formation by binding with exposed tissue factor. Anecdotal reports have described the utility of FVIIa in correcting coagulopathy from trauma, but no large series exists. We present our experience with 81 coagulopathic trauma patients treated using FVIIa in years 2001-2003, compared with "control" patients matched from the trauma registry from the same time period. Methods: Use of FVIIa was restricted to active hemorrhage with clinical coagulopathy. We recorded the cause of coagulopathy, dose of FVIIa administered, effect on clinical coagulation, pertinent laboratory values, length of stay, number and type of blood products administered, and patient outcome. For the same time period we also examined outcomes in coagulopathic patients who did not receive FVIIa. Results: Causes of coagulopathy were diverse, and included acute traumatic hemorrhage (46 patients), traumatic brain injury (20), warfarin use (9), congenital Factor VII deficiency (2), and other acquired hematologic defects (4). Coagulopathy was reversed in 61/81 cases (75%), with an associated reduction in PT from 19.6 to 10.8 (p = 0.000018). 34 patients (42%) survived to hospital discharge (20/46 traumatic hemorrhage, 5/20 TBI, 4/9 on warfarin, 2/2 factor deficient, 3/4 other). Patients died from irreversible shock, multiple organ system failure, or traumatic brain injury. FVIIa patients had a higher mortality than coagulopathic controls matched by specific anatomic injuries, admission lactate value, and predicted probability of survival. Only a group identified by all three characteristics had a similar mortality to the FVIIa cohort, but the number of patients that could be matched this way was too small to be meaningful. Conclusion: FVIIa therapy lead to an immediate reduction in coagulopathic hemorrhage in most cases, accompanied by a significant improvement in laboratory measures. Application of FVIIa as a therapy of last resort makes the identification of equivalent control patients difficult. Use of FVIIa should be considered for any patient with coagulopathic hemorrhage in which surgically-accessible bleeding has been controlled. Prospective trials of FVIIa in patients with traumatic coagulopathy are strongly indicated, and should focus on appropriate patient selection and the dose and timing of therapy.

Original languageEnglish (US)
Pages (from-to)709-719
Number of pages11
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume57
Issue number4
DOIs
StatePublished - Oct 2004

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Factor VIIa
Hemorrhage
Wounds and Injuries
Warfarin
Factor VII Deficiency
Multiple Organ Failure
Mortality
Factor VIII
Thromboplastin
Thrombin
Patient Selection
Registries
Shock
Lactic Acid
Length of Stay

ASJC Scopus subject areas

  • Surgery

Cite this

Dutton, R. P., McCunn, M., Hyder, M., D'Angelo, M., O'Connor, J., Hess, J. R., ... Schreiber, M. (2004). Factor VIIa for correction of traumatic coagulopathy. Journal of Trauma - Injury, Infection and Critical Care, 57(4), 709-719. https://doi.org/10.1097/01.TA.0000140646.66852.AB

Factor VIIa for correction of traumatic coagulopathy. / Dutton, Richard P.; McCunn, Maureen; Hyder, Mary; D'Angelo, Matthew; O'Connor, James; Hess, John R.; Scalea, Thomas M.; Schurr, Michael J.; Yukioka, Tetsuo; Owings, John T; Holcomb, John B.; Hoyt, J. David; Morris, John A.; Velmahos, George; Schreiber, Martin.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 57, No. 4, 10.2004, p. 709-719.

Research output: Contribution to journalArticle

Dutton, RP, McCunn, M, Hyder, M, D'Angelo, M, O'Connor, J, Hess, JR, Scalea, TM, Schurr, MJ, Yukioka, T, Owings, JT, Holcomb, JB, Hoyt, JD, Morris, JA, Velmahos, G & Schreiber, M 2004, 'Factor VIIa for correction of traumatic coagulopathy', Journal of Trauma - Injury, Infection and Critical Care, vol. 57, no. 4, pp. 709-719. https://doi.org/10.1097/01.TA.0000140646.66852.AB
Dutton, Richard P. ; McCunn, Maureen ; Hyder, Mary ; D'Angelo, Matthew ; O'Connor, James ; Hess, John R. ; Scalea, Thomas M. ; Schurr, Michael J. ; Yukioka, Tetsuo ; Owings, John T ; Holcomb, John B. ; Hoyt, J. David ; Morris, John A. ; Velmahos, George ; Schreiber, Martin. / Factor VIIa for correction of traumatic coagulopathy. In: Journal of Trauma - Injury, Infection and Critical Care. 2004 ; Vol. 57, No. 4. pp. 709-719.
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AU - Hyder, Mary

AU - D'Angelo, Matthew

AU - O'Connor, James

AU - Hess, John R.

AU - Scalea, Thomas M.

AU - Schurr, Michael J.

AU - Yukioka, Tetsuo

AU - Owings, John T

AU - Holcomb, John B.

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