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McSwain, Norman E nmcswai at tulane.edu
Thu Dec 23 21:56:16 GMT 2010


Does anyone have any solid data that it works? Has there ever been study
looking at times that showed a difference? I ask because I have never
seen one. Just antidotes.

Norman
Norman McSwain MD, FACS
Professor, Tulane School of Medicine
Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO 
norman.mcswain at tulane.edu
504 988 5111


-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Mark Forrest
Sent: Thursday, December 23, 2010 3:27 PM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: MTP

Stuke
We have certainly found that you can give it too late. Our original
protocol was basically to consider it after 18 units of blood (not quite
sure where the figure came from) but at this late stage it never
appeared to work in our hands, so we now at least 'consider it' as soon
as we activate our massive transfusion protocol and after TXA.

But we also ensure other necessary  factors are present and that a
reasonable degree of homeostasis is present or it definitely won't work.
Saying that sometimes we do everything by the book and it still doesn't
seem to do much!

You can certainly give it too late but also too early too ( Yoram Kluger
trialled it with paramedics in Israel with no improvement). 

Timing and patient selection, when and to whom remains the big question!

Regards
Mark



Sent from my iPhone

On 23 Dec 2010, at 19:39, "Stuke, Lance E." <lstuke at lsuhsc.edu> wrote:

> I've had little success with Factor VIIa, and rarely use it now at
Charity, as I don't believe it works. However, I wonder if I've been
using it incorrectly. For example - I usually give it as a last-ditch
salvage attempt in a trauma patient who is already severely
coagulopathic after I've operated on them in a damage-control situation.
These patients have usually had several blood volumes replaced and are
requiring ongoing blood product replacement. I suspect most of us have
used it in a similar fashion.
> 
> What if we gave it in the operating room immediately after getting
control of surgical bleeding instead of waiting until the patient is
near extremis? Has anybody tried this already?  It may be something to
consider in a multi-institutional trial in trauma centers with high
rates of operative trauma (Charity, BenTaub, Grady, etc). Perhaps giving
it early instead of late in the course of resuscitation will improve its
efficacy. I doubt it, and I'm not a fan, but a study like this could put
the issue to rest. 
> 
> Stuke
> 
> Lance Stuke, MD, MPH
> Spirit of Charity Trauma Center
> Assistant Professor of Surgery
> LSU Department of Surgery
> New Orleans, LA
> 
> 
> ________________________________
> 
> From: trauma-list-bounces at trauma.org on behalf of Karim Brohi
> Sent: Thu 12/23/2010 1:51 AM
> To: Trauma-List [TRAUMA.ORG]
> Subject: Re: MTP
> 
> 
> 
> We never really used Factor VIIa routinely in trauma haemorrhage - we
> were part of both the Phase II and Phase III (CONTROL) factor 7 trials
> and it was used occasionally in extremis with variable effect.  It was
> never included in our protocols because we felt we did not know where
> it's place was in the transfusion/coagulopathy armamentarium.
> Unfortunately I think that is still the case.
> 
> Fundamentally the design of CONTROL was flawed and based on limited
> available data.  Many always expected CONTROL to be negative because
> of the low acuity of the target population (changed from the Phase II
> study).  (This is similar to the positive to negative switch in the
> PROWESS to ADDRESS in the activated protein C studies).
> 
> Lack of effect in CONTROL  (above the identified reduction in
> transfusion requirements) does not necessarily mean rFVIIa has no
> effect in trauma patients.  We still don't know A) Which trauma
> patients develop low coagulation factor levels, what induces this and
> when it occurs during haemorrhage and B) which trauma patients respond
> optimally to procoagulant therapy (F7a, PCC, Fibrinogen or FFP), when
> and in what dose.
> 
> So I wouldn't use rVIIa in trauma patients at the moment but I
> wouldn't write it (or its newer analogues) off yet, there's a lot more
> to learn.
> 
> Karim
> 
> On Wed, Dec 22, 2010 at 13:28, Juan Duchesne <jduchesn at tulane.edu>
wrote:
>> No. Since we instituted DCR into our MTP back in 06-07, we've used
factor 7 rarely ( 2-3 times a year).
>> J
>> 
>> Sent from my iPhone from Spirit of Charity Trauma Center, NOLA
>> 
>> 
>> On Dec 22, 2010, at 1:10, Tchaka Shepherd <tshepherdmd at hotmail.com>
wrote:
>> 
>>> 
>>> Has anyone found it advantageous to add factor seven or factor nine
to their MTP?
>>> 
>>> 
>>> NOTHING  SPLENDID Has Ever Been Achieved Except By Those Who DARED
BELIEVE THAT SOMETHING INSIDE THEM  Was Superior to CIRCUMSTANCE
>>> 
>>> 
>>> 
>>> 
>>> 
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> <winmail.dat>
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