Knudson et al identified factors associated with a poor response to recombinant Factor VIIa therapy in trauma patients. These can help to identify a patient who may benefit from additional or alternative therapy. The authors are from the University of California San Francisco, the United States Army Institute of Surgical Research and the University of Texas at Houston.


Patient selection: major trauma with hemorrhage


Poor outcomes: death, thrombosis, organ failures, prolonged ICU stay


Factors at the time of administration that may be associated with a poor response to recombinant Factor VIIa therapy:

(1) hypotension with systolic blood pressure <= 90 mm Hg

(2) acidosis with arterial pH < 7.2

(3) thrombocytopenia with a platelet count < 100,000 per µL



• The presence of thrombocytopenia following traumatic injury raises the possibility of DIC. It also raises the possibility of dilutional coagulopathy, with 18 units being the average blood transfusions prior to factor VIIa infusion.


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