Recombinant factor VIIa

[Sacamuelas]

Originally Posted by The Reaper

BTW, last time I checked, Warfarin WAS the rodenticide, Coumadin, et al were the anti-coagulants.

TR

Coumadin is simply the brand name form of warfarin. Air .177 is correct.

[Sacamuelas]

Peregrino-

Check out these videos for some VERY specific presentations on the coagulation pathways and how they relate to administration of factor VIIa. Note: If you haven't already had physiology and some medical training these videos aren't for you.

trauma surgeon's perspective:

http://www.bloodline.net/stories/storyReader$3107

http://www.bloodline.net/stories/storyReader$3108

hematology researcher's perspective:

http://www.bloodline.net/stories/storyReader$3103

IMO, from reviewing this information, it isn't very reasonable to carry "on you". Having it in a trauma surgeon's tool bag in a nearby field trauma hospital might be nice though depending on your injuries.

Your plavix and Asa 81mg treatments both work to decrease initial platelet aggregation at the site. I don't see how factor VIIa would do much to "reverse" the complications from taking these meds. At best, it would help mitigate the effects by increasing other pathways involved in hemostasis after a major trauma.

FWIW, Factor VIIa does seem to have an important potential in advanced trauma management when treating patients who have had massive fluid resuscitation attempts as part of their management in the intial stabilization process. THAT seems to me very pertinant to this particular forum... maybe we can discuss this aspect and flush it out further. Perhaps this factor VIIa could be given at the initial triage facility(ex. base camp) and prevent the coagulopathy sometimes encountered after stabilization from beginning and provide less chance of subsequent complications.

Of course, for me to do this I would have to review all my old physiology info and combine it with what is discussed in the recent literature on this factor VIIa. Swatsurgeon or Doc T might be able to discuss in detail without having to dredge it up as they deal with these type issues daily.

I ask a question and disappear...thanx for the answer. As I said, that is what I thought....

Factor VIIa (recombinant) promotes hemostasis by activating one of the pathways your body uses to form clots (extrinsic for thoses who understand this stuff). It forms a complex with tissue factor that is exposed at sites of injury and causes activation of different coagulation (clotting) factors. Through a few more steps a hemostatic (clot) plug gets formed and hemostasis (cessation of bleeding) hopefully occurs.

It is great for coagulopathic bleeding, not surgical bleeding. It will not stop an artery from bleeding out.

It is easy to carry...it stays in powder form until used and is mixed with sterile water.

Studies are equivical as to if it really works in trauma but I am a believer and have used it multiple times. They are going to start a large multi=center trial soon in the US. It is costly though...around 6000-10,000 a dose depending on the size of the patient and the amount used...

doc t.

[DoctorDoom]

x

[Peregrino]

Originally Posted by DoctorDoom

Peregrino,

I don't think that Novoseven would be of any help to you, as you want to be slightly coagulopathic because of your stents. Factor VIIa is for those who are deficient in coagulation factors and need to return to normal coaglative states, which you do not want, and by a pathway unrelated to your stents. If you are bruising easily speak to your cardiologist; they may be able to adjust the dosing of your medications to try to reduce that adverse side effect of your meds.

Good luck,

DD

DD - Roger all. I watched the clips Saca sent, read Doc T's comments, did some independant Google-Fu, and figured out it wasn't for me (or anyone in similar straits - warfarin/coumadin OD would be a different animal). Back to the original issue - coagulopathy isn't something I would expect an 18D to successfully treat in the field. The only place I could imagine using it would be in an ICU. I can't believe the price of it either. It has been interesting learning about it though. Peregrino

[Odin21]

In a publication on Lessons Learned a SFC Alex Alvarez reportedly used rVIIa in the field to help control bleeding in a noncompressable abdominal hemorrhage. He advocates form more rVIIa to be carried as well. The write up is on page five of this PDF.


https://www.google.com/url?sa=t&sour...z_s7p1Saisgjkw

[RichL025]

Originally Posted by Odin21

In a publication on Lessons Learned a SFC Alex Alvarez reportedly used rVIIa in the field to help control bleeding in a noncompressable abdominal hemorrhage. He advocates form more rVIIa to be carried as well. The write up is on page five of this PDF.


https://www.google.com/url?sa=t&sour...z_s7p1Saisgjkw

Can't open the link.

There are plenty of anecdotal "saves" using rFVIIa. I have even given it once or twice myself and thought it contributed to hemostasis... But the plural of "anecdote" is not data...

It has been fairly well established that NovoSeven is NOT the bleeding panacea we once thought it was. While I could not open that link, I really, really doubt that the F7 had any role in saving that patient.

Given the current data on it's effectiveness, and role in traumatic coagulopathy, and the logistical problems even with the "room temperature stable" product, I think it would be a fool's errand to equip 18Ds with it. Tranexamic acid, on the other hand, appears to be both beneficial, safe, temperature stable and relatively cheap.