Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial.

This is a very important, landmark article describing for the first time the efficacy of an antifibrinolytic, tranexamic acid (TA), to decrease mortality in bleeding trauma patients. The study enrolled 20,211 adult trauma patients who were randomized to receive a short course of TA (2 g total) or placebo. The risk of death was decreased […]

Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials.

The etiology of severe hemorrhage associated with trauma includes coagulopathy, hypothermia, acidosis, as well as platelet dysfunction, in addition to the direct effect of trauma itself. This important large international randomized placebo controlled study in blunt and penetrating trauma showed a significant reduction in blood transfusion requirement in patients with blunt trauma who received rFVIIa, […]

Factor VIIa for correction of traumatic coagulopathy.

This paper reports the use of rFVIIa in 81 patients who suffered with traumatic bleeding over a period of 30 months in a large trauma center. The center set guidelines for using rFVIIa in patients with severe uncontrolled bleeding and associated coagulopathy. Results were compared to series of matched control groups for comparison. There was […]

HBOC-201 improves survival in a swine model of hemorrhagic shock and liver injury.

This experimental study highlights the potential beneficial therapeutic effect of a hemoglobin-based oxygen carrier (HBOC) used as a resuscitation fluid during severe traumatic shock. In contrast to colloid (high molecular weight hydroxyethyl starch) based resuscitation, a similar volume of HBOC from bovine origin prevented exsanguination cardiac arrest, allowing for significantly higher long term (96 hr) […]

Updates in the management of severe coagulopathy in trauma patients.

This is a very good review on the pathophysiological changes which occur following trauma and the associated coagulopathy. Thrombo-cytopenia, hypotheromia, acidosis, and fibrinolysis are among factors which lead to coagulopathy. Evidence is mounting for the efficacy of rFVIIa in managing bleeding in trauma patients. – M. Aldouri

Early use of recombinant factor VIIa improves mean arterial pressure and may potentially decrease mortality in experimental hemorrhagic shock: A pilot study.

This is an interesting work showing the efficacy of rFVIIa in controlling post traumatic hemorrhage in an animal model, especially after the publication of several case reports of the effective treatment of excessive bleeding following surgery or trauma in non-hemophiliac patients with rFVIIa. After avulsion of left median lobe of the liver, swines were randomized […]

Recombinant activated factor VII for adjunctive hemorrhage control in trauma.

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 […]