The following are prerequisites for the use of recombinant factor VIIa in bleeding trauma patients EXCEPT:

The following are prerequisites for the use of recombinant factor VIIa in bleeding trauma patients EXCEPT:

a. Platelet count >50x109/L.

b. Temperature >36°C.

c. Fibrinogen >0.5g/L.

d. pH >7.20.

e. Ionised Ca2+ >0.8mmol/L (3.2mg/dL).

B

• ·        Recombinant factor VIIa (rFVIIa) may be helpful to induce coagulation in areas of diffuse small vessel coagulopathic bleeding.

·        It follows that all surgical avenues to control bleeding must first be explored.

·        Adequate platelet numbers are required to generate the ‘thrombin burst’ which the rFVIIa provokes, and adequate fibrinogen must be present to translate this thrombin generation into clot formation.

·        Correction of severe acidosis, hypothermia and hypocalcaemia are also warranted to maximise the chances of success for this expensive and unlicensed therapy.

·        However, a temperature of 36°C is difficult to achieve in such patients; 32°C is considered an appropriate minimum threshold.