Modulation of the Coagulation Cascade Using Recombinant Factor VIIa and Activated Protein C in a Severely Injured Trauma Patient

European Journal of TraumaCase StudyModulation of the Coagulation Cascade

Using Recombinant Factor VIIa and Activated

Protein C in a Severely Injured Trauma PatientAdnan Z. Rizvi, Denetta S. Slone, Martin A. Schreiber1AbstractExsanguination after trauma remains a leading cause

of early death in severely injured patients [1]. Sepsis and

multiple organ failure are significant causes of mortality

in severely injured trauma patients who survive their

injury and require a prolonged ICU hospitalization [2].

Despite advances in operative technique and critical

care medicine, the treatment options for patients

with coagulopathic hemorrhage or severe sepsis have

remained relatively unchanged. We report a unique

case in which pharmacological modulators of coagulation, recombinant Factor VIIa, and activated protein C

were successfully used to treat massive hemorr-hage

and then severe sepsis in a severely injured trauma

patient.Key Words

Recombinant factor VIIa Activated protein C

Trauma Hemorrhage SepsisEur J Trau ma 2006;32:399403DOI 10.1007/s00068-005-5044-7Case StudyA 38-year-old homeless man fell from a height of 25 feet

onto concrete, landing on his abdomen. He did not lose

consciousness, and was able to walk two blocks to call 911

from a pay phone. Upon arrival of Emergency Medical

Services, the patient had a Glasgow Coma Scale score

of 15 but was obviously intoxicated. He complained of

upper abdominal pain. Initial blood pressure and heart

rate were 135/74 and 104, and he was not in respiratory

distress. He was quickly transported by ambulance to

Oregon Health & Science University. On arrival, the patient was hemodynamically stable

with a blood pressure of 154/109 and a heart rate of 102,

but he continued to complain of diffuse upper abdominal pain. Initial hematocrit was 43.5%, and an arterial

blood gas revealed a pH of 7.31 with a base deficit of 4.7. After the initial survey, the patients blood pressure

dropped to 76/45. Two liters of crystalloid were rapidly

infused, and his blood pressure improved to 96/62.

Abdominal computed tomography revealed a significant quantity of free fluid, a Grade I splenic laceration,

and a Grade IV liver laceration extending into the gallbladder fossa. There was no contrast blush evident. The

patient remained hemodynamically stable throughout

the exam and was taken to the ICU for further treatment. After arrival at the ICU, the patient had a second

hypotensive episode and was taken...