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Old 08-01-2005, 17:33   #16
Doc T
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thanx.

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.
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Old 08-02-2005, 03:29   #17
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x

Last edited by DoctorDoom; 07-29-2013 at 08:54.
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Old 08-02-2005, 08:40   #18
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Originally Posted by DoctorDoom
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
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Old 02-17-2014, 09:57   #19
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rVIIa used by SF medic in Afghanistan

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&sour...z_s7p1Saisgjkw

Last edited by Odin21; 02-17-2014 at 13:25.
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Old 02-17-2014, 19:07   #20
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Originally Posted by Odin21 View Post
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&sour...z_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.
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Old 02-17-2014, 23:23   #21
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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).

Last edited by Patriot007; 02-17-2014 at 23:25.
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Old 02-18-2014, 11:27   #22
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Lessons Learned PDF

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.
Attached Files
File Type: pdf 0401 Medics Lessons Learned 110614(3).sflb.pdf (108.9 KB, 6 views)
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Old 02-18-2014, 11:41   #23
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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.
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Old 02-18-2014, 11:42   #24
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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
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