Use of rFVIIa in the trauma setting - Practice patterns in United States trauma centers

John D. Horton, Kent J. Dezee, Michel Wagner

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8 Scopus citations

Abstract

Much excitement has been generated regarding the off label use of recombinant factor VIIa (rFVIIa) in the severely injured trauma patient. The purpose of our study is 3-fold: 1) describe the type of centers that use rFVIIa, 2) determine which centers use the drug more frequently, and finally 3) investigate how this drug is being administered at trauma centers. A survey was mailed or e-mailed to 435 trauma centers (Level I and II) throughout the nation. One hundred fifty-six surveys were returned. American College of Surgeons (ACS) verification and trauma Level I designation were independent predictors of rFVIIa use (odds ratio [OR] 3.74 and 5.40, P < 0.05). High users of rFVIIa were defined as those centers that had above median usage of the drug. Level I centers accounted for 67 per cent of the high users. Only the number of fellowship-trained trauma surgeons and trauma volume predicted high usage of rFVIIa (OR 1.38 and 14.09, P < 0.05). Trauma volume predicted whether or not Factor VII users implemented a protocol based approach to administration of the drug (OR 6.57, P < 0.05). Most protocols incorporated packed red blood cells (74%) before giving rFVIIa. The dose of 90 mcg/kg was exceeded in 34 per cent of centers, and 3 per cent used the 200 mcg/kg dose. High volume Level I trauma centers use rFVIIa more frequently and are more likely to use a systematic approach to its administration. However, there is no standardized approach to rFVIIa administration in United States trauma centers.

Original languageEnglish (US)
Pages (from-to)413-417
Number of pages5
JournalAmerican Surgeon
Volume74
Issue number5
Publication statusPublished - May 1 2008

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ASJC Scopus subject areas

  • Surgery

Cite this

Horton, J. D., Dezee, K. J., & Wagner, M. (2008). Use of rFVIIa in the trauma setting - Practice patterns in United States trauma centers. American Surgeon, 74(5), 413-417.