Successful use of recombinant activated factor VII for trauma-associated hemorrhage in a patient without preexisting coagulopathy.

This is a detailed first case report in the United States on using recombinant activated factor VIIa in treating massive uncontrollable bleeding following stab wound trauma to the liver in a patient with no pre-existing coagulopathy. Bleeding was not controlled in spite of two laparotomies, the transfusion of a large number of blood components and the use of surgical packing and fibrin sealant and arterial embolization. After 45 hours, bleeding was dramatically controlled with a single dose of rFVIIa of 90 μg/kg and the use of blood components greatly diminished. The patient died after 5 weeks of initial trauma due to Candida sepsis, and there was no evidence for myocardial ischemia. This case report is another example on the efficacy of rFVIIa in controlling severe bleeding following trauma in non-hemophiliac patients.

– M. Aldouri.