In trauma patients, coagulopathy is generally treated with fresh frozen plasma (FFP). However, FFP may take hours to administer and can cause complications by requiring large volumes of fluid. In this retrospective study, conducted over a 2-year span, the authors reviewed 84 trauma patients with mild to moderate coagulopathy who received a low dose of recombinant factor VIIa (rVIIa) in addition to FFP and blood component therapy.

• 67% of patients had traumatic brain injury (TBI) as primary injury
• Etiology of coagulopathy included TBI, 40%; warfarin use, 22%; and cirrhosis, 13%
• All patients were given 1.2 mg of rVlla, equating to the lowest available unit dose (off-label dosing)
• No determination of efficacy could be made due to lack of a control group

• All patients had a good clinical response, with no bleeding complications
• Utilization of packed red blood cells (PRBCs) and FFP was significantly less in the 24 hours after rVlla administration than in the 24 hours before (P =.0019 and P <.0001, respectively). Blood product use is depicted in Figure 1
• Mean prothrombin time fell from 17.0 s (±3.2) to 10.6 s (±1.4) (P <.0001) (see Figure 2)
• Subsequent thromboembolic events were observed in 12 of the 81 patients; only 4 of these events were thought to be related to study treatment
• The 1.2-mg dose of rVlla costs approximately $1000 USD (equivalent to ≈8 U of plasma administered)

• Use of low-dose rVlla rapidly and effectively treats mild to moderate coagulopathy following injury and may be effective in coagulopathic trauma patients who are not in shock but who require rapid normalization of clotting function
• Administration of a 1.2-mg dose was generally safe but was thought to contribute to thromboembolic events in 4 of 81 patients
• Use of low-dose rVlla in these patients allowed for instantaneous reversal of coagulopathy but did not subject patients to high volumes of fluid or the risks of blood product administration

In trauma patients with mild to moderate coagulopathy following injury, low-dose rVlla proved to be a rapid and effective treatment that did not subject patients to high volumes of fluid or the risks of blood product administration.

• PCC was effective in correcting dilutional coagulopathy and controlling bleeding in an in vivo porcine trauma model
• PCC warrants further investigation as treatment for dilutional coagulopathy in trauma and surgery based on its suitability for more rapid administration than FFP
• The favorable effects of PCC support a potential role for its use in treating traumatic and surgical coagulopathy

In a preclinical trauma animal model, under conditions of hemodilution and hemorrhage, PCC proved superior to FFP in normalizing PT and peak thrombin generation and controlling bleeding.