Brown Carlos V R, Foulkrod Kelli H, Lopez Daniel, Stokes John, Villareal Jesus, Foarde Katie, Curry Eardie, Coopwood Ben
Department of Surgery, University of Texas Southwestern Medical School - Austin, University Medical Center Brackenridge - Trauma Services, Austin, Texas 78701, USA.
J Trauma. 2010 Feb;68(2):348-52. doi: 10.1097/TA.0b013e3181bbfb6b.
Recombinant activated factor VII (rFVIIa) has been associated with decreased blood transfusion requirements in trauma patients. Clinical use has recently been extended to the treatment of coagulopathic patients with traumatic brain injury, and results have been encouraging. However, the cost and possible thromboembolic complications of rFVIIa have been considered barriers to its widespread use. We hypothesize that rFVIIa would provide an effective and cost efficient means of correcting coagulopathy in patients with traumatic brain injury undergoing emergent craniotomy.
We performed a 2-year (2005-2006) retrospective study of adult blunt trauma patients with traumatic brain injury who presented coagulopathic (international normalized ratio [INR] >1.3) and required emergent craniotomy. We compared patients who did (rFVIIa group) and did not (no-rFVIIa group) receive rFVIIa to correct coagulopathy before craniotomy.
There were 14 rFVIIa patients and 14 no-rFVIIa patients. The rFVIIa patients were older (59 years vs. 41 years, p = 0.04), but there was no difference in male gender (79% vs. 79%, p = 0.68), injury severity score (29 vs. 29, p = 1.0), or Glasgow Coma Scale score (10 vs. 7, p = 0.67). Although there was no difference in admission INR (2.6 vs. 1.9, p = 0.10), the rFVIIa group was more often taking preinjury coumadin (57% vs. 14%, p = 0.05). The rFVIIa group had a preoperative INR (1.2 +/- 0.4 vs. 1.4 +/- 0.2, p = 0.05), but there was no difference in the time from admission to craniotomy (135 minutes vs. 182 minutes, p = 0.51). The rFVIIa group received fewer units of packed red blood cells (PRBCs) and plasma during the perioperative period. In addition, the rVIIa group consumed fewer costs of PRBC ($756 per patient vs. $2,916 per patient, p < 0.001) and plasma ($369 per patient vs. $927 per patient, p = 0.001). The rFVIIa group still consumed fewer total costs of transfused blood products when cost of rFVIIa was included ($2,557 per patient vs. $4,110 per patient, p = 0.04). There were no thromboembolic complications in either group.
rFVIIa provides a cost-efficient option to effectively correct coagulopathy in patients with traumatic brain injury undergoing emergent craniotomy. In addition, the use of rFVIIa is associated with decreased transfusion of PRBC and plasma and decreased transfusion-related hospital costs in this population.
重组活化凝血因子 VII（rFVIIa）与创伤患者输血需求减少有关。其临床应用最近已扩展至治疗创伤性脑损伤的凝血病患者，结果令人鼓舞。然而，rFVIIa 的成本及可能的血栓栓塞并发症被认为是其广泛应用的障碍。我们推测，rFVIIa 可为接受急诊开颅手术的创伤性脑损伤患者纠正凝血病提供一种有效且具成本效益的方法。
我们对 2005 年至 2006 年期间因钝性创伤导致创伤性脑损伤且出现凝血病（国际标准化比值[INR]>1.3）并需要急诊开颅手术的成年患者进行了一项为期 2 年的回顾性研究。我们比较了在开颅手术前接受（rFVIIa 组）和未接受（非 rFVIIa 组）rFVIIa 纠正凝血病的患者。
rFVIIa 组有 14 例患者，非 rFVIIa 组有 14 例患者。rFVIIa 组患者年龄较大（59 岁对 41 岁，p = 0.04），但男性比例（79%对 79%，p = 0.68）、损伤严重程度评分（29 对 29，p = 1.0）或格拉斯哥昏迷量表评分（10 对 7，p = 0.67）无差异。尽管入院时 INR 无差异（2.6 对 1.9，p = 0.10），但 rFVIIa 组更常服用伤前华法林（57%对 14%，p = 0.05）。rFVIIa 组术前 INR 较低（1.2±0.4 对 1.4±0.2，p = 0.05），但从入院到开颅手术的时间无差异（135 分钟对 182 分钟，p = 0.51）。rFVIIa 组围手术期接受的浓缩红细胞（PRBC）和血浆单位较少。此外，rVIIa 组 PRBC 成本较低（每位患者 756 美元对每位患者 2916 美元，p < 0.001）和血浆成本较低（每位患者 369 美元对每位患者 927 美元，p = 0.001）。当计入 rFVIIa 成本时，rFVIIa 组输注血液制品的总成本仍较低（每位患者 2557 美元对每位患者 4110 美元，p = 0.04）。两组均无血栓栓塞并发症。
rFVIIa 为有效纠正接受急诊开颅手术的创伤性脑损伤患者的凝血病提供了一种具成本效益的选择。此外，在该人群中使用 rFVIIa 与 PRBC 和血浆输注减少以及输血相关住院成本降低有关。
