Document Detail


Recombinant factor VIIa is effective at reversing coagulopathy in a lactic acidosis model.
MedLine Citation:
PMID:  22002618     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The interplay of coagulopathy, acidosis, and hypothermia contributes to the death of the most seriously injured trauma patients. Because of in vitro testing and retrospective series, current recommendations advise correcting acidosis before administering recombinant factor VII (rFVIIa).
METHODS: A lactic acidosis was induced in 40 kg swine, and 10 blood samples were withdrawn for testing. rFVIIa was added to the samples with and without bicarbonate correction of the pH. Conventional coagulation assays as well as rotational thromboelastography (ROTEM) were performed on these in vitro samples. Additionally, 10 acidotic and coagulopathic animals had rFVIIa administered after randomization to pH correction with bicarbonate, or remaining acidotic. Conventional coagulation and ROTEM assays were performed on the animals.
RESULTS: Ex-vivo samples had a mean pH of 7.14 and International Normalized Ratio (INR) of 1.46. Addition of rFVIIa to these samples corrected the INR to 0.98 (p < 0.05). A similar effect was seen for the ROTEM extem Clotting Time (extem CT). Bicarbonate correction alone of these samples had only a modest effect on INR (1.36, p < 0.05). When administered in vivo to acidotic animals (pH, 7.15), rFVIIa lowered the INR from 1.49 to 1.01 (p < 0.05). Similar improvements in extem CT were seen.
CONCLUSIONS: rFVIIa is effective at reversing the coagulopathy from lactic acidosis in a large animal model. Recommendations against its use in acidotic patients may not be valid.
Authors:
Richard N Lesperance; Ryan K Lehmann; Dawn M Harold; Alec C Beekley; James A Sebesta; Matthew J Martin
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  72     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2012-02-08     Completed Date:  2012-04-13     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  123-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Madigan Army Medical Center, Tacoma, Washington 98431, USA. richard.lesperance@us.army.mil
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MeSH Terms
Descriptor/Qualifier:
Acidosis, Lactic / complications,  drug therapy*
Animals
Blood Coagulation Disorders / drug therapy*,  etiology
Blood Coagulation Tests
Disease Models, Animal
Factor VIIa / therapeutic use*
Recombinant Proteins / therapeutic use
Shock, Hemorrhagic / drug therapy
Swine
Chemical
Reg. No./Substance:
0/Recombinant Proteins; 0/recombinant FVIIa; EC 3.4.21.21/Factor VIIa

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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