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Early Use of Recombinant Factor VIIa Improves Mean Arterial Pressure and May Potentially Decrease Mortality in Experimental Hemorrhagic Shock: A Pilot Study

Lynn, Mauricio MD; Jerokhimov, Igor MD; Jewelewicz, Dory MD; Popkin, Charles BA; Johnson, Edward W. BS; Rashid, Qammar N. MS, MD; Brown, Margareth RN, MSN; Martinowitz, Uri MD; Cohn, Stephen M. MD, FACS

The Journal of Trauma: Injury, Infection, and Critical Care: April 2002 - Volume 52 - Issue 4 - p 703-707
Original Articles

Background  Recombinant factor VIIa (rFVIIa) is used for treatment of bleeding episodes in hemophilia patients who develop inhibitors to factors VIII and IX. We tested the hypothesis that administration of rFVIIa early after injury would decrease bleeding and improve survival after experimental hepatic trauma.

Methods  Anesthetized swine were cannulated for blood sampling and hemodynamic monitoring. Avulsion of left median lobe of the liver induced uncontrolled hemorrhage. After a 10% reduction of mean arterial pressure, animals were blindly randomized to receive intravenous rFVIIa (180 μg/kg) (n = 6) or placebo (n = 7).

Results  Mortality was 43% (three of seven) in controls versus 0% with rFVIIa (p = 0.08, χ2). Significantly shorter prothrombin time and higher mean arterial pressures were observed in the rFVIIa group.

Conclusion  Intravenous administration of rFVIIa early after induction of hemorrhage shortens prothrombin time and improves mean arterial pressure. A trend toward improved survival was observed.

From the Divisions of Trauma and Surgical Critical Care, University of Miami School of Medicine (M.L., I.J., D.J., C.P., E.W.J., Q.R., M.B., S.M.C.), Miami, Florida, and the National Hemophilia Center (U.M.), Sheba Medical Center, Tel Hashomer, Israel.

Submitted for publication May 15, 2001.

Accepted for publication November 30, 2001.

Presented at the 31st Annual Meeting of the Western Trauma Association, February 24–March 1, 2001, Big Sky, Montana.

Address for reprints: Mauricio Lynn, MD, Divisions of Trauma and Surgical Critical Care (D-40), University if Miami School of Medicine, P.O. Box 016960, Miami, FL 33101.

© 2002 Lippincott Williams & Wilkins, Inc.