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New Options for Better Control of Blood Loss in Neurosurgical Patients: Presented at ASA

By Arushi Sinha, PhD

SAN FRANCISO, CA -- October 19, 2007 -- Use of activated factor VIIa (FVIIa) appears to decrease the need for blood transfusions during surgery in patients with traumatic brain injuries (TBI), according to a study presented here at the Annual Meeting of the American Society of Anesthesiologists (ASA).

Surgical treatment of patients with coagulopathies has always presented a challenge, according to the study researchers, led by Trung Vu, MD, Third-Year Resident, MD, Associate Professor, Division of Trauma Anaesthesiology, University of Maryland Medical System, Baltimore, Maryland, United States. Difficulties in establishing normal coagulation can delay surgery, while performing surgery in patients with coagulopathies can result in substantial intraoperative blood loss.

FVIIa is a potent procoagulant agent that promotes haemostasis. Activated FVIIa was developed to treat haemophiliacs, but in recent years it has been suggested that this agent could be used for rapid correction of coagulopathy and to decrease perioperative bleeding.

Therefore, Dr. Vu and colleagues conducted their study to examine the role of activated FVIIa in decreasing the need for transfusion during neurosurgery in patients with TBI.

The researchers designed a retrospective study of 57 TBI patients who received activated FVIIa either before or during the surgical procedure. A control group sample was comprised of the same number of patients undergoing neurosurgery for TBI who did not receive activated FVIIa.

For the purposes of this study, blood products were defined as packed red blood cells (pRBC) or fresh frozen plasma (FFP).

Results show that the patients who received activated FVIIa received 2.3 units of pRBC and 3.5 units of FFP, while the control group patients received 10 units of pRBC and 24.9 units of FFP, a significant difference (P <.0001).

"FVIIa does decrease the use of FPP and other blood products," Dr. Vu said.

"The most significant finding is that [activated] FVIIa was used for haemophiliacs in the past and today it may be used for severe intraoperative bleeding when we have trouble controlling haemorrhaging shock," explained Dr. Vu.

"We did not find any significant difference in ICU stay, hospital stay, or mortality," He added.

Based on these results, the team concluded that the use of activated FVIIa decreased the need for the perioperative transfusion among neurosurgical patients with TBI.

Therefore, the researchers urge further study of this agent as a means for more effective surgical outcomes in TBI patients.


[Presentation title: Factor VIIa Decreases Transfusion in Patients With Traumatic Brain Injury Undergoing Craniotomy. Abstract A1081]

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