Massive bleeding in trauma and surgery: role of rFVIIa

ABSTRACT

Uncontrolled hemorrhage is the leading cause of death in trauma patients. It also constitutes a major cause of perioperative morbidity and mortality. The most of critically traumatized patients as well as many postoperative patients suffer profound bleeding accompanied by systemic coagulopathy. When the routine corrective measures have been exhausted and still there does not seem to be any respite, the anesthesiologists and intensivists are in great dilemma and panic attack of [what next]? rFVIIa [NovoSeven[R]7, has already been approved and successfully recommended in many coagulopathies [both congenital as well as acquired] and abnormalities of platelet function [past or present refractoriness to platelet transfusion]. However, there are very few guidelines, if any, on its use for surgical / traumatic massive and uncontrolled bleeding. Because of the recent trends in rFVIIa usage in non-approved settings by physicians of various disciplines, significant concerns about its safety, efficacy and costs have arisen. In addition because of lack of randomized trials, the dosing is not yet standardized. An effort has been made to discuss its off label uses in massive bleeding, especially due to trauma and in the perioperative period. Also review of available guidelines has been mentioned along with recommendations: