Accession Number:

ADA629434

Title:

Use of Recombinant Factor VIIa in US Military Casualties for a Five-Year Period

Descriptive Note:

Journal article

Corporate Author:

ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX

Report Date:

2010-08-01

Pagination or Media Count:

8.0

Abstract:

Two prospective randomized trauma trials have shown recombinant factor VIIa rFVIIa to be safe and to decrease transfusion requirements. rFVIIa is presently used in 22 of massively transfused civilian trauma patients. The US Military has used rFVIIa in combat trauma patients for five years, and two small studies of massively transfused patients described an association with improved outcomes. This study was undertaken to assess how deployed physicians are using rFVIIa and its impact on casualty outcomes. Methods US combat casualties n 2,050 receiving any blood transfusion from 2003 to 2009 were reviewed to compare patients receiving rFVIIa n 506 with those who did not n 1,544. Propensity-score matching primary analysis and multivariable logistic regression were used to compare outcomes. Differences were determined at p less than 0.05. Results Twenty-five percent of patients received rFVIIa. Significant differences were noted between groups in indices of injury severity Injury Severity Score, Abbreviated Injury Scale score, and Glasgow Coma Scale score, admission physiology systolic blood pressure, diastolic blood pressure, heart rate, temperature, base deficit, hemoglobin, and international normalization ratio, and use of blood products, indicating that patients treated with rFVIIa were more severely injured, in shock, and coagulopathic. For propensity-score matching, factors associated with death were used Injury Severity Score, Glasgow Coma Scale score, heart rate, systolic blood pressure, diastolic blood pressure, Hgb, and total packed red blood cell. A total of 266 patients per group were matched 52 of the rFVIIa group. After pairing, there were no significant differences in any of the demographics, including incidence of massive transfusion 53 vs. 51. There was no difference in the rate of complications 21 vs. 21 or mortality 14 vs. 20 for patients not treated or receiving rFVIIa, respectively.

Subject Categories:

  • Anatomy and Physiology
  • Medicine and Medical Research
  • Pharmacology
  • Military Forces and Organizations

Distribution Statement:

APPROVED FOR PUBLIC RELEASE