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Doc T
07-25-2005, 22:32
Okay...

discussion at lunch today. Do SF medics carry this stuff with them...I said no way but my partner insists that they do and that they give it, on occasion, before going into "battle"...

any comments?

doc t.

Eagle5US
07-26-2005, 09:55
That's a big negatory good buddy. SF Medics don't carry the stuff.
Nice to see you around DocT :cool:

Eagle

Kyobanim
07-26-2005, 10:24
Now that I've done my google research . . .

Why isn't it carried and used? It looks as though it it would be helpfull. Or does it fall into that category of "can't use it enough to justify the space it takes up in the bag"?

Peregrino
07-26-2005, 10:33
Doc T - Now that I've Googled to find out what you were talking about - Why would an SF medic carry/use the stuff? What I read seems to imply it's for hemophilia or reversing an anticoagulant and doesn't look applicable to field trauma management. I'm not a medic/medical professional - I'm just curious! I'm interested because they pumped me full of Heperin during my MI and I've been on Plavix and 81mg ASA every since. Look at me hard and I bruise, cuts take a while to quit bleeding. Thank God, no Warfarin. So I've got a personal interest and questions about CAD, clotting factors, and IV coagulants in the event of traumatic injury. Peregrino

Team Sergeant
07-26-2005, 12:02
Doc T - Now that I've Googled to find out what you were talking about - Why would an SF medic carry/use the stuff? Peregrino

Ugh, hence the reason she placed it in here and not the weapons forum, so SF medics/Doc's could answer.... (and the reason she did't ask me.) :rolleyes:

Peregrino
07-26-2005, 13:09
Ugh, hence the reason she placed it in here and not the weapons forum, so SF medics/Doc's could answer.... (and the reason she did't ask me.) :rolleyes:

Think of it as cross-training. I'm actually interested in the answer (when she gets finished with everything else she's responsible for). And I don't blame you for dodging the bullet. Us "knuckledraggers" gots to know our limits! :D Peregrino

casey
07-26-2005, 13:22
Look at me hard and I bruise, cuts take a while to quit bleeding. Peregrino

Von Willebrands disease ?

jasonglh
07-26-2005, 13:39
I am a little curious why you would be on both Plavix and 81mg ASA. Do you have chronic Atrial fibrillation as well?

Peregrino
07-26-2005, 13:40
Von Willebrands disease ?

CAD - Coronary artery disease, heart attack while running PT. I'm one of the lucky ones, I survived. Now I get to take Plavix (and other things) forever. It reduces clotting so I have the other problems. Not much fun but it beats the alternative. Peregrino

J - Cause that's what the Cardiologist put me on. It's been reviewed and continued several times since so I have to assume there's a reason.

DoctorDoom
07-27-2005, 03:39
x

Peregrino
07-27-2005, 08:46
Pretty common for people with stents, especially drug eluting stents. Chronic afib usually gets coumadin.

DD - Correct. I had mine put in three weeks before the drug coated stints became available. Apparently I wasn't a candidate for them anyway (size issue). And I'm very happy not to take rat poison the rest of my life (knock on wood). Course nobody has said yet if I should read some more about the recombinant Factor VII. :munchin Peregrino

The Reaper
07-27-2005, 09:07
Course nobody has said yet if I should read some more about the recombinant Factor VII. :munchin Peregrino

Thank you for finally bringing this back to the topic.

BTW, last time I checked, Warfarin WAS the rodenticide, Coumadin, et al were the anti-coagulants.

TR

Air.177
07-27-2005, 09:16
Thank you for finally bringing this back to the topic.

BTW, last time I checked, Warfarin WAS the rodenticide, Coumadin, et al were the anti-coagulants.

TR
by my understanding They are the same thing, One being the generic equiv. of the other. I have been wrong though.

Good times,
blake

Sacamuelas
07-27-2005, 09:25
BTW, last time I checked, Warfarin WAS the rodenticide, Coumadin, et al were the anti-coagulants.

TR

Coumadin is simply the brand name form of warfarin. Air .177 is correct.

Sacamuelas
07-27-2005, 14:07
Peregrino-

Check out these videos for some VERY specific presentations on the coagulation pathways and how they relate to administration of factor VIIa. Note: If you haven't already had physiology and some medical training these videos aren't for you.

trauma surgeon's perspective:

http://www.bloodline.net/stories/storyReader$3107

http://www.bloodline.net/stories/storyReader$3108

hematology researcher's perspective:

http://www.bloodline.net/stories/storyReader$3103

IMO, from reviewing this information, it isn't very reasonable to carry "on you". Having it in a trauma surgeon's tool bag in a nearby field trauma hospital might be nice though depending on your injuries.

Your plavix and Asa 81mg treatments both work to decrease initial platelet aggregation at the site. I don't see how factor VIIa would do much to "reverse" the complications from taking these meds. At best, it would help mitigate the effects by increasing other pathways involved in hemostasis after a major trauma.

FWIW, Factor VIIa does seem to have an important potential in advanced trauma management when treating patients who have had massive fluid resuscitation attempts as part of their management in the intial stabilization process. THAT seems to me very pertinant to this particular forum... maybe we can discuss this aspect and flush it out further. Perhaps this factor VIIa could be given at the initial triage facility(ex. base camp) and prevent the coagulopathy sometimes encountered after stabilization from beginning and provide less chance of subsequent complications.

Of course, for me to do this I would have to review all my old physiology info and combine it with what is discussed in the recent literature on this factor VIIa. Swatsurgeon or Doc T might be able to discuss in detail without having to dredge it up as they deal with these type issues daily. :munchin

Doc T
08-01-2005, 18:33
I ask a question and disappear...thanx for the answer. As I said, that is what I thought....

Factor VIIa (recombinant) promotes hemostasis by activating one of the pathways your body uses to form clots (extrinsic for thoses who understand this stuff). It forms a complex with tissue factor that is exposed at sites of injury and causes activation of different coagulation (clotting) factors. Through a few more steps a hemostatic (clot) plug gets formed and hemostasis (cessation of bleeding) hopefully occurs.

It is great for coagulopathic bleeding, not surgical bleeding. It will not stop an artery from bleeding out.

It is easy to carry...it stays in powder form until used and is mixed with sterile water.

Studies are equivical as to if it really works in trauma but I am a believer and have used it multiple times. They are going to start a large multi=center trial soon in the US. It is costly though...around 6000-10,000 a dose depending on the size of the patient and the amount used...

doc t.

DoctorDoom
08-02-2005, 04:29
x

Peregrino
08-02-2005, 09:40
Peregrino,

I don't think that Novoseven would be of any help to you, as you want to be slightly coagulopathic because of your stents. Factor VIIa is for those who are deficient in coagulation factors and need to return to normal coaglative states, which you do not want, and by a pathway unrelated to your stents. If you are bruising easily speak to your cardiologist; they may be able to adjust the dosing of your medications to try to reduce that adverse side effect of your meds.

Good luck,

DD

DD - Roger all. I watched the clips Saca sent, read Doc T's comments, did some independant Google-Fu, and figured out it wasn't for me (or anyone in similar straits - warfarin/coumadin OD would be a different animal). Back to the original issue - coagulopathy isn't something I would expect an 18D to successfully treat in the field. The only place I could imagine using it would be in an ICU. I can't believe the price of it either. It has been interesting learning about it though. Peregrino

Odin21
02-17-2014, 09:57
In a publication on Lessons Learned a SFC Alex Alvarez reportedly used rVIIa in the field to help control bleeding in a noncompressable abdominal hemorrhage. He advocates form more rVIIa to be carried as well. The write up is on page five of this PDF.


https://www.google.com/url?sa=t&source=web&rct=j&ei=hC8CU8b3BsWGyAH16IHIBQ&url=http://www.naemt.org/Libraries/PHTLS%2520TCCC/0401%2520Medics%2520Lessons%2520Learned%2520110614 .sflb&cd=1&ved=0CCYQFjAA&usg=AFQjCNFW4xbYMPs--j4Iz_s7p1Saisgjkw

RichL025
02-17-2014, 19:07
In a publication on Lessons Learned a SFC Alex Alvarez reportedly used rVIIa in the field to help control bleeding in a noncompressable abdominal hemorrhage. He advocates form more rVIIa to be carried as well. The write up is on page five of this PDF.


https://www.google.com/url?sa=t&source=web&rct=j&ei=hC8CU8b3BsWGyAH16IHIBQ&url=http://www.naemt.org/Libraries/PHTLS%2520TCCC/0401%2520Medics%2520Lessons%2520Learned%2520110614 .sflb&cd=1&ved=0CCYQFjAA&usg=AFQjCNFW4xbYMPs--j4Iz_s7p1Saisgjkw

Can't open the link.

There are plenty of anecdotal "saves" using rFVIIa. I have even given it once or twice myself and thought it contributed to hemostasis... But the plural of "anecdote" is not data...

It has been fairly well established that NovoSeven is NOT the bleeding panacea we once thought it was. While I could not open that link, I really, really doubt that the F7 had any role in saving that patient.

Given the current data on it's effectiveness, and role in traumatic coagulopathy, and the logistical problems even with the "room temperature stable" product, I think it would be a fool's errand to equip 18Ds with it. Tranexamic acid, on the other hand, appears to be both beneficial, safe, temperature stable and relatively cheap.

Brush Okie
02-17-2014, 20:02
Can't open the link.

There are plenty of anecdotal "saves" using rFVIIa. I have even given it once or twice myself and thought it contributed to hemostasis... But the plural of "anecdote" is not data...

It has been fairly well established that NovoSeven is NOT the bleeding panacea we once thought it was. While I could not open that link, I really, really doubt that the F7 had any role in saving that patient.

Given the current data on it's effectiveness, and role in traumatic coagulopathy, and the logistical problems even with the "room temperature stable" product, I think it would be a fool's errand to equip 18Ds with it. Tranexamic acid, on the other hand, appears to be both beneficial, safe, temperature stable and relatively cheap.

What about side effects? I am thinking clots in peripheral veins with low perfusion turning to an embolism? I am just thinking of possible side effects not knowing a lot about the medication its self but understanding the principal behind it.

Patriot007
02-17-2014, 23:23
What about side effects? I am thinking clots in peripheral veins with low perfusion turning to an embolism? I am just thinking of possible side effects not knowing a lot about the medication its self but understanding the principal behind it.

Yes, a drug that clots well has the potential to clot vessels you don't want just as much as the ones you do. All of you that are familiar with tPA (tissue plasminogen activator) the "clot busting" medicine use in ischemic strokes and heart attacks know that the risk of giving it is causing fatal intracranial hemorrhage among other bleeding.

It takes large studies to help us figure out the population of patients in whom the bleeding risk is low compared to the benefit.

So similarly, we need to define the risk of thrombosis and the population that would benefit the most from FVII and this takes large studies. Even "large" studies are not enough sometimes to draw conclusions since trauma patients are so heterogeneous (mechanism and injuries) even compared to strokes and heart attack patients.

The data is fairly robust on Tranexamic acid on the other hand as my surgical colleague has stated and many if not most agree there is a benefit if given EARLY (within 3 hours).

Odin21
02-18-2014, 11:27
Let me see if I can get the PDF up as an attachment. It is fairly interesting reading in its own right in addition to mentioning the field use of rVIIa.

RichL025
02-18-2014, 11:41
Let me see if I can get the PDF up as an attachment. It is fairly interesting reading in its own right in addition to mentioning the field use of rVIIa.

Thanks - good read.

Regarding Alvarez's use of rFVIIa, it had absolutely zero bearing on that casualty surviving... but good for him for trying everything he could think of in a difficult situation.

At best rFVIIA is a band-aid to buy some time to correct a coaguloapthy while you are getting control of surgical bleeding.

swatsurgeon
02-18-2014, 11:42
It's not like TXA that we can give in the field and see significant improvements. Factor 7 is an adjunct to control surgical bleeding, ie. in th OR with the surgeon and all of th other adjuncts available