Rekombinanter Faktor VIIa in der Hämorrhagiebehandlung des Schwerstverletzten

Abstract

The aim of the study was to assess whether the use of recombinant factor VIIa (rFVIIa) in trauma patients was associated with improved outcome. Patients documented in the TraumaRegistry of the German Society for Trauma Surgery (primary admissions; Injury Severity Score, ISS ≥ 9) who received rFVIIa in the first 6 hours upon admission (rFVIIa +) were matched with patients that had not received rFVIIa (rFVIIa-). The matching comparison yielded two identical groups with 100 patients each (rFVIIa+: average age 40.6 ± 18.5 years, ISS 47.1 ± 16.7 versus rFVIIa-: 40.1 ± 19.1 years, ISS 45.1 ± 15.6). Patients were administered an average of 18.3 ± 13.1 (rFVIIa+) versus 19.5 ± 14.0 (rFVIIa-) red blood cell units (p = 0.55) and 15.2 ± 13.7 (rFVIIa+) versus 15.0 ± 13.1 (rFVIIa-) units of fresh frozen plasma (p = 0.92). Thromboembolisms occurred in 5% (rFVIIa+) versus 2% (rFVIIa-) (p = 0.44), multiple organ failure (MOF) in 82% versus 62% (p = 0.003) and hospital mortality was 48% versus 43% (p = 0.57), respectively. The early use of rFVIIa in severely injured patients was not associated with either lower transfusion requirements or with mortality reduction but with increased MOF.