Martin Jeremiah T, Alkhoury Fuad, McIntosh Bryan C, Fidler Phillip, Schulz John
Hospital of Saint Raphael, 1450 Chapel St, New Haven, CT 06511, USA.
Eplasty. 2009 Jul 1;9:e27.
Recombinant factor VIIa (rFVIIa; NovoSeven) is well recognized as an effective hemostatic agent in the management and prophylaxis of patients with hemophilia. We report here the successful use of rFVIIa in a coagulopathic burn patient.
A 63-year-old man was admitted with significant upper-body burns in a total body surface area of 60%. Initial management included early intubation and escharotomies, with subsequent admission to the burn unit. Fascial excision was carried out with allograft placement. During a complicated hospital course, decline in platelet function was noted and was associated with the development of a generalized coagulopathy with elevated international normalized ratio. Following a routine follow-up debridement and autografting, extensive bleeding was noted from donor sites. A period of increasing hemodynamic instability followed in the burn unit, with serial hematocrit measurements pointing toward ongoing bleeding from the surgical sites. Following administration of significant amounts of blood product, it was decided to administer rFVIIa per pharmacy protocol.
Within 4 hours of administration of rFVIIa, the patient was noted to be hemodynamically stable with unchanging serial hematocrit measurements. Hemostasis was attributed to the use of rFVIIa with prior administration of platelets.
Our case demonstrates the successful use of rFVIIa in the severely coagulopathic burn patient.
重组凝血因子VIIa（rFVIIa；诺其）在血友病患者的治疗和预防中被公认为一种有效的止血剂。我们在此报告rFVIIa在一名凝血功能障碍烧伤患者中的成功应用。
一名63岁男性因上身大面积烧伤入院，烧伤总面积达60%。初始治疗包括早期插管和焦痂切开术，随后转入烧伤病房。进行了筋膜切除并植入了异体皮。在复杂的住院过程中，发现血小板功能下降，并伴有国际标准化比值升高的全身性凝血功能障碍。在一次常规的随访清创和自体植皮术后，供皮区出现大量出血。烧伤病房随后出现血流动力学不稳定加剧的情况，连续的血细胞比容测量表明手术部位持续出血。在输注了大量血液制品后，决定按照药房方案给予rFVIIa。
在给予rFVIIa后4小时内，患者血流动力学稳定，连续的血细胞比容测量结果无变化。止血归因于使用rFVIIa并预先输注了血小板。
我们的病例证明rFVIIa在严重凝血功能障碍的烧伤患者中使用成功。
