RESUMO
Recombinant factor VII was first developed for control and prevention of bleeding in haemophilia with antibodies to factor VIII and IX. Its efficacy in these situations is well established. Over recent years, the 'off-label' use of this substance has become more widespread in trauma, surgery and obstetric bleeding. Here we describe the mechanism of action of recombinant factor VII, review current literature of 'off-label' usage and our initial experience in surgical related cases of bleeding at Epworth Hospital.
Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Fator VIIa/farmacologia , Hemostasia/efeitos dos fármacos , Assistência Perioperatória , Proteínas Recombinantes/farmacologia , Austrália , Fator VIIa/administração & dosagem , Fator VIIa/uso terapêutico , Humanos , Proteínas Recombinantes/administração & dosagem , Proteínas Recombinantes/uso terapêuticoRESUMO
OBJECTIVES: To determine whether MRI of the cervical spine resulted in a change in management of patients with blunt trauma and normal plain X-ray (XR)/CT of the cervical spine. METHODS: An explicit chart review was conducted of patients seen at a Level 1 trauma centre over a 1 year period. Clinical details were extracted from the charts of patients with blunt trauma who had a normal plain XR and CT scan of the cervical spine and who underwent cervical spine MRI. A comparison of clinical details was made between those with a normal/abnormal MRI secondary to the acute injury. RESULTS: One hundred and thirty-four patients met entry criteria. Discharge non-operative management of the cervical spine was associated with a change in management by the MRI result (P < 0.0001) where MRI of the cervical spine occurred a median of 3 days (interquartile range 0-4.5, range 0-137) after the injury. The MRI occurred before discharge 90% of the time in both groups. Operative management occurred in three patients and was delayed until after first outpatient review in two patients. CONCLUSIONS: An abnormal MRI after normal plain XR and CT cervical spine studies resulted in a change in non-operative management at discharge. Early MRI resulted in one patient receiving surgery before discharge. No unstable injuries were detected by MRI that were not evident on plain XR or CT cervical spine.