This is a relatively new area for using rFVIIa, which is to treat uncontrolled haemorrhage in patients with severe trauma, following the earlier report of using rFVIIa successfully in treating bleeding in a soldier who suffered with bullet injur (Kenet et al., Lancet 1999;354:1879). rFVIIa was effective in controlling bleeding and resulted in significant reduction in transfusion requirement, PT and APTT. Existing coagulopathy in such patients was not worsened by using rFVIIa due to its local haemostatic action on site of injury rather than systemically. Causes of coagulopathy in patients with sever trauma are discussed.

The dose of rFVIIa used was variable and further studies will be required to decide the optimum dose. The authors recommend a high initial dose, and the concomitant use of inhibitors of fibrinolysis.

– M. Aldouri.