Application of recombinant factor VIIa for refractory bleeding in patients with liver trauma – case reports


Authors: Mannová Hillová Jitka 1;  Seidlová Dagmar 1;  Mašek Michal 2;  Zimová Iveta 1;  Ševčík Pavel 1
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny FN Brno, Lékařská fakulta MU Brno 1;  Klinika úrazové chirurgie FN Brno, Lékařská fakulta MU Brno, ČR 2
Published in: Anest. intenziv. Med., 21, 2010, č. 5, s. 239-244
Category: Intesive Care Medicine - Case Report

Overview

Surgical treatment is required in unstable trauma patients with liver damage and patients with grade IV–V liver trauma. The practice of damage control surgery has become widely accepted as a standard strategy in the management of these patients. A necessary part of the complex treatment must be the management of coagulopathy. Application of recombinant factor VIIa has shown to be effective when other modalities had failed.

Recombinant factor VIIa (rFVIIa ) treatment in patients with extensive liver damage is presented in three case reports. In the first one, the rFVIIa was administered for the treatment of coagulopathy when standard therapy had failed, in the second case to control refractory bleeding in liver trauma after performing peri-hepatic packing, and the last one in patients with progressive intra-parenchymal hepatic bleeding in whom surgical treatment had not been recommended. Questions remain about the optimal dosing of rFVIIa, the timing of treatment, administration of additional doses and the frequency of thrombo-embolic events.

Keywords:
liver trauma – bleeding – coagulopathy – recombinant factor VIIa


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Labels
Anaesthesiology, Resuscitation and Inten Intensive Care Medicine
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