The effect of recombinant factor VIIa on coagulopathic @entity1707 with grade V XXXX .

@entity1 @entity1707 @entity82 @entity548 @entity447 @entity190 @entity99 @entity130
BACKGROUND: Recombinant factor VIIa (rFVIIa) has been used to decrease @entity548 in a number of settings including @entity447 , liver transplantation, intractable @entity548 , and @entity82 . Experience in the @entity130 setting is limited. This study was performed to determine whether rFVIIa would reduce @entity548 after a grade V @entity99 in hypothermic, dilutionally coagulopathic @entity1707 when used as an adjunct to abdominal packing and to determine whether increasing the dose of the drug increased its hemostatic efficacy. METHODS: Thirty animals were randomized to receive 180 microg/kg of rFVIIa, 720 microg/kg of rFVIIa, or vehicle buffer control. After laparotomy and splenectomy, animals underwent a 60% blood volume isovolemic exchange transfusion with 5% @entity1 albumin. The animals' temperature was maintained at 33 degrees C and a standardized grade V @entity99 was made with a liver clamp. Thirty seconds after injury, the abdomen was packed with laparotomy sponges, resuscitation was initiated, and blinded therapy was given. Animals were resuscitated to their baseline mean arterial pressure and the study was continued for 2 hours. Serial coagulation parameters were measured at the temperature they were drawn. After the study period, surviving animals were killed, posttreatment @entity190 was measured, and an autopsy was performed. RESULTS: Ten animals were randomized to each group. After administration of study drug, factor VII clotting activity (FVII:C) was higher in the 720 microg/kg group than in the 180 microg/kg group (p < 0.01). FVII:C was higher in both treatment groups than in the control group (p < 0.01). The mean prothrombin time was shorter in the treatment groups than in the control group (p < 0.05). Mean arterial pressure was lower in the control group than in the treatment groups throughout the study (p < 0.01). Mean @entity190 was less in the treatment groups than in the control group (p = 0.03). Mortality was not different between groups. There were no differences between the groups that received rFVIIa in any measured parameters except for FVII:C. @entity99 were similar between groups and there was no evidence of microthrombosis on lung histology. CONCLUSION: rFVIIa reduces @entity190 in hypothermic, dilutionally coagulopathic @entity1707 with grade V injuries when used as an adjunct to packing. Increasing the dose does not enhance the hemostatic effect.
