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Sat Jan 17 08:55:07 GMT 2009

We have also not given Factor 7 for some time now, and are using a higher
(but not 1:1) plasma dose than previously (give very little crystalloid and
no colloid).  Having said that we never really incorporated it into our
protocols and outside of the CONTROL trial really never gave the drug.  Not
because we don't think it works but because, as Ken says, we simply didn't
know who to give it to, or when.
Which is a shame, because I do believe it has a place somewhere in the
anti-TIC armamentarium.  Moreover, I think it's probably safer (and
definitely less immunogenic) to give a dose of F7a than 10 or 15 units of
FFP.  Whether F7a is equivalent to 10 units of FFP (or 5 or 15) is another
matter.  There's a lot more work to be done, and we need to get a lot better
at identifying the pattern of coagulopathy and directing therapy - probably
with multiple interventions.  It's a shame there'll probably be no further
funded research into Factor 7.  I'm hopeful for Son of factor 7 - not as a
panacea as NovoSeven was promoted - but as a procoagulant drug to be used to
treat TIC).

Also keep an eye out for Factor XIII, which looks like it might be
interesting.

K

2009/1/16 <KMATTOX at aol.com>

> I agree with the group from Charity in New Orleans and Tulane.  If you  do
> not give large volumes of crystalloid, your requirements for rVIIa will
> basically disappear.
>
> k
>
>
>
>
>
>
> In a message dated 1/16/2009 7:45:02 A.M. Central Standard Time,
> Marc_Matthews at medprodoctors.com writes:
>
> Juan,
>
> Thank you. I would like to set up triggers for my  surgeons. I will read
> this
> ASAP.
>
> Thanks,
>
>
> -  MRM
>
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> -----Original  Message-----
> From: trauma-list-bounces at trauma.org  [mailto:
> trauma-list-bounces at trauma.org]
> On Behalf Of Duchesne, Juan C
> Sent: Friday, January 16, 2009 5:25 AM
> To: Trauma &amp; Trauma  &amp
> Subject: RE: Factor VII (7) clinical triggers for use in the  trauma OR
>
> Dear Marc- since the institution of Early Hemostatic  Resuscitation at
> Charity, NO we counted only 2 cases were factor VII was used  over the last
> 2 years,
> for which both patients end up dying. Based on our  experience we decided
> to
> look further into this question. The below reference  may be of help:
> Good Luck
> Juan
>
> Current evidence based guidelines  for factor VIIa use in trauma: the good,
> the bad, and the ugly.
> <
> https://ent.tulane.edu/pubmed/19097529?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel
> .
> Pubmed_RVDocSum>
>
> Duchesne JC, Mathew KA, Marr AB, Pinsky MR, Barbeau JM, McSwain  NE.
>
> Am Surg. 2008 Dec;74(12):1159-65.
>
>
> Juan C. Duchesne MD,  FACS, FCCP
> Director Surgical Hospital Center
> Director Tulane Surgical  Intensive Care Unit AMR Regional Director
> Louisiana
> Emergency Response  Network
>
>
> Division of Trauma and Critical Care Surgery Tulane &  LSU Department of
> Surgery and Anesthesiology 1430 Tulane Ave., SL-22 New  Orleans LA
> 70112-2699 Tel.
> 504-988-5111 Fax.  504-988-3683
>
>
>
>
>
> ________________________________
>
> From:  trauma-list-bounces at trauma.org on behalf of Marc Matthews - MedPro
> MMC
>  X
> Sent: Thu 1/15/2009 9:34 PM
> To: Trauma &amp
> Subject: RE: Factor  VII (7) clinical triggers for use in the trauma OR
>
>
> All,
>
> Does anybody have clinical triggers for the use of  Factor VII (7) in the
> trauma OR? I am looking for any institution that has a  guideline based on
> the
> literature for the triggers that they could share with  me and anyone on
> this
> list server. I am looking to educate and provide  economically sound advice
> on a
> very expensive medication. There have to be  guidelines in trauma centers.
>
> Anyone with a guideline or protocol  regarding this would help as well as
> any
> salient pieces of advice in its use  or non-use.
>
> Thank you,
>
> MRM
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Factor VII (7) clinical triggers for use in the trauma OR