Although the adequate and timely use of rFVIIa in the treatment of trauma is promising, there are still no protocol parameters relative to precise indications or contraindications. It is worth noting that the use of rFVIIa has improved the control of intractable bleeding due to coagulopathy in seriously injured patients, and it is important to consider this option for the control of coagulopathy in order to address acidosis and hypothermia as perpetuating factors. 1. Brohi K, Mitchell J, Cohenb, Ross A, Davenporta. Acute coagulopathy of trauma: mechanism, identification and effect. Curr Opin Crit Care. 2007;13:680â685. 2. Charles A, Shaikh AA, Walters M, Huehl S, Pomerantz R. Bloodtransfusion is an independent predictor of mortality after blunttrauma. Am Surg. 2007;73:1â5. 3. Kheirabadi BS, Crissey JM, Deguzman R, Holcomb JB. In vivobleeding time and in vitro thrombelastography measurements are better indicators of dilutional hypothermic coagulopathy thanprothrombin time.J rauma.2007;62:1352â1359 4. Rugeri L, Levrat A, David JS, et al. Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography.JThrombHaemost. 2007;5:289 â295. 5. Borgman MA, Spinella PC, Perkins JG, et al. The ratio of bloodproducts transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63:805â 813. 7. MacLeod JB, Lynn M, McKenney M, Cohn S, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma. 2003; 551:39-44. 9. Stahel PF,Moore EE,Schreier SL, Flierl MA,Kashuk JL. Transfusion Strategies in Posinjury Coagulophaty. Curr Opin Anesth. 2009;22:289-298. 10. Brohi K, Cohen MJ, Ganter MT, et al. Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J Trauma.2008; 64:1211â1217. 11. 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Theresuscitative fluid you choose may potentiate bleeding. J Trauma. 2006;61:1350 â1358. 19. Ho AM, Karmakar MK, Dion PW. Are we giving enough coagulation factors during major trauma resuscitation?. Am J Surg 2005;190:479â484. 20. Hirshberg A, Dugas M, Banez EI, Scott BG, Wall MJ, Mattox KL. Minimizing dilutional coagulopathy in exsanguinating hemorrhage: a computer simulation. J Trauma 2003;54:454â463. 21. Brazil EV, Coats TJ. Sonoclot coagulation analysis of in-vitro haemodilution with resuscitation solutions. J R Soc Med 2000;93:507â510. 22. Vincent JL, Rossaint R, Riou B, Ozier Y, Zideman D, Spahn DR. Recommendations on the use of rFVIIa as an adjunctive treatment for massive bleeding -a European perspective. Critical Care 2006; 10: R120. 23. Reed RL II, Bracey AW, Jr., Hudson JD, Miller TA, Fischer RP.Hypothermia and blood coagulation: dissociation between enzyme activity and clotting factor levels. Circ Shock. 1990;32:141â152. 24. Wolberg AS, Meng ZH, Monroe DM III, Hoffman M. A systematic evaluation of the effect of temperature on coagulation enzyme activity and platelet function. J Trauma. 2004;56:1221â1228. 25. Meng ZH, Wolberg AS, Monroe DM III, Hoffman M. The effect oftemperature and pH on the activity of factor VIIa: implications forthe efficacy of high-dose factor VIIa in hypothermic and acidoticpatients. J Trauma. 2003;55:886â891. 26. Wolberg AS, Meng ZH, Monroe DM, Hoffman MA. systematic evaluation ofthe effect of temperature on coagulation enzyme activity and platelet function.J Trauma 2004; 56:1221â1228. 27. Martini WZ, Pusateri AE, Uscilowicz JM, DelgadoAV, HolcombJB. Independent contributions of hypothermia and acidosis tocoagulopathy in swine. J Trauma. [discussion] 2005;58:1009â1010. 28. Cosgriff N, Moore EE, Sauaia A,Moynihan K, Burch JM,Galloway B. Predicting life-threatening coagulopathy in the massively transfused trauma patient: hypothermia and acidoses revisited. J Trauma. [discussion] 1997;42:857â 861. 29. Martini WZ, Dubick MA, Wade CE,Holcomb JB. Evaluation of tris-hydroxymethyl aminomethane on reversing coagulation abnormalities caused by acidosis in pigs. Crit Care Med. 2007;35:1568 â1574. 30. Levi M, van der Poll T, ten Cate H, van Deventer SJ. The cytokine mediated imbalance between coagulant and anticoagulant mechanisms in sepsis and endotoxaemia. Eur J Clin Invest. 1997;27:3â9. 31. Shebuski RJ, Kilgore KS. Role of inflammatory mediators in thrombogenesis. J Pharmacol Exp Ther. 2002;300:729 â735. 32. Chesebro BB, Rahn P, Carles M,Esmon C, Jun X, Brohi K, Frith D, Pittet J-P, Cohen M. Increase in activated protein c mediates acute traumatic coagulopathy in mice. Shock. 2009 Dec 32;6:659-665. 33. Rugeri L, Levrat A, David JS, et al. Diagnosis of early coagulation abnormalitiesin trauma patients by rotation thrombelastography. J Thromb Haemost 2007; 5:289â295. 34. Devenport RA, Brohi K. Coagulophaty in trauma patients : Importance of thrombocyte function?.Curr Opin Anesth.2009;22:261-266. 35. Oliver M. Theusinger D R, Ganter M. Transfusion in trauma: why and how should we change our current practice? Curr Opn Anaesth 2009,22:000â000 38. American College of Surgeons Committee on Trauma: Advanced Trauma Life SupportATLSCourse for Physicians,edn 7.Chicago:American College of Surgeons;2008. 39. Sorensen B, Ingerslev J. Tailoring haemostatic treatment to patient requirements - an update on monitoring haemostatic response using thrombelastography. [Suppl] Haemophilia 2005 11; 1:1-6. 40. Brown RB, Klar J, Teres D, Lemeshow S, Sands M. Prospective study of clinical bleeding in intensive care unit patients. Crit Care Med. 1988 Dec 1612:1171-6. 41. Stein D, Dutton R, Kramer M, Scalea T. Reversal of Coagulopathy in Critically Ill Patients With Traumatic Brain Injury: recombinant Factor VIIa is More Cost-Effective Than Plasma. J Trauma 2009;66: 63â75. 43. Martinowitz U, Holcomb JB, Pusateri AE, et al. Intravenous rFVIIa administered for hemorrhage control in hypothermic coagulopathic swine ith grade V liver injuries. J Trauma 2001; 50:721â729. 44. Bartal C, Yitzha A. The role of thromboelastometry and recombinant factor VIIa in trauma, Curr Opin Anaesthesiol 2009 Apr; 222:281â288 45. Hellstern P, Halbmayer WM, Kohler M et al. Prothrombin complex concentrates: indications, contraindications, and risks: a task force summary. Thromb Res 1999; 95:S3âS6. 48. Van Veen SQ, Strengers PF. Use of prothrombin complex concentrates in anticoagulation. Am J Hematol 2008; 83:344â345. 50. Rigby AC, Grant MA. Protein S: a conduit between anticoagulation and inflammation. Crit Care Med. 2004;32:S336 âS341
El rFVIIa como tratamiento en el trauma promete buenos resultados con uso adecuado, en el momento correcto sin tener aún parámetros protocolizados en relación con indicaciones precisas o contraindicaciones; cabe anotar, que el uso del mismo, es importante una vez se ha hecho control vascular del sangrado, asociado a la corrección de la acidosis e hipotermia, como factores perpetuantes.