Current evidence based guidelines for factor VIIa use in trauma: the good, the bad, and the ugly.

摘要: Recombinant factor VII (rFVIIa) has arisen as an option for the control of life-threatening traumatic bleeding unresponsive to other means. The timing administration, dosage, mortality, units blood transfusion saved, risk thrombotic events, and risk/benefits ratio are presently poorly defined. A Medline search from 1995 through March 2008 was conducted. All English language articles containing terms "trauma" "factor VII" or its variants were retrieved. Letters editor, animal studies, general reviews excluded. total 19 met inclusion criteria. These then reviewed stratified into three classes evidence according quality assessment instrument developed by Brain Trauma Foundation. Levels recommendation developed. 118 identified. Only one Class I study This demonstrated that doses rFVIIa given in blunt hemorrhage yielded a significant reduction 2.6 red cells used. findings not statistically penetrating trauma patients. There no mortality increase thromboembolic events. Four II studies identified; showed decrease product usage reductions 24-hour 30 day death patients receiving rFVIIa. remaining 14 III databases, registries, case series, reports. No identified specifically addressed cost/benefit analysis hemorrhage. Utility trauma-associated remains controversial. is Level supporting use only. decreased differences Minimal effective dosing regimens analyses have yet been examined.