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    Safety of rFVIIa in hemodynamically unstable polytrauma patients with traumatic brain injury: Post hoc analysis of 30 patients from a prospective, randomized, placebo-controlled, double-blind clinical trial

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    Author
    Kluger, Y; Riou, B; Rossaint, R; Rizoli, SB; Boffard, KD; Choong, PIT; Warren, B; Tillinger, M
    Date
    2007-01-01
    Source Title
    Critical Care (UK)
    Publisher
    BMC
    University of Melbourne Author/s
    Choong, Peter
    Affiliation
    Surgery (St Vincent's)
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Kluger, Y., Riou, B., Rossaint, R., Rizoli, S. B., Boffard, K. D., Choong, P. I. T., Warren, B. & Tillinger, M. (2007). Safety of rFVIIa in hemodynamically unstable polytrauma patients with traumatic brain injury: Post hoc analysis of 30 patients from a prospective, randomized, placebo-controlled, double-blind clinical trial. CRITICAL CARE, 11 (4), https://doi.org/10.1186/cc6092.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/256040
    DOI
    10.1186/cc6092
    Abstract
    BACKGROUND: Trauma is a leading cause of mortality and morbidity, with traumatic brain injury (TBI) and uncontrolled hemorrhage responsible for the majority of these deaths. Recombinant activated factor VIIa (rFVIIa) is being investigated as an adjunctive hemostatic treatment for bleeding refractory to conventional replacement therapy in trauma patients. TBI is a common component of polytrauma injuries. However, the combination of TBI with polytrauma injuries is associated with specific risk factors and treatment modalities somewhat different from those of polytrauma without TBI. Although rFVIIa treatment may offer added potential benefit for patients with combined TBI and polytrauma, its safety in this population has not yet been assessed. We conducted a post hoc sub analysis of patients with TBI and severe blunt polytrauma enrolled into a prospective, international, double-blind, randomized, placebo-controlled study. METHODS: A post hoc analysis of study data was performed for 143 patients with severe blunt trauma enrolled in a prospective, randomized, placebo-controlled study, evaluating the safety and efficacy of intravenous rFVIIa (200 + 100 + 100 microg/kg) or placebo, to identify patients with a computed tomography (CT) diagnosis of TBI. The incidences of ventilator-free days, intensive care unit-free days, and thromboembolic, serious, and adverse events within the 30-day study period were assessed in this cohort. RESULTS: Thirty polytrauma patients (placebo, n = 13; rFVIIa, n = 17) were identified as having TBI on CT. No significant differences in rates of mortality (placebo, n = 6, 46%, 90% confidence interval (CI): 22% to 71%; rFVIIa, n = 5, 29%, 90% CI: 12% to 56%; P = 0.19), in median numbers of intensive care unit-free days (placebo = 0, rFVIIa = 3; P = 0.26) or ventilator-free days (placebo = 0, rFVIIa = 10; P = 0.19), or in rates of thromboembolic adverse events (placebo, 15%, 90% CI: 3% to 51%; rFVIIa, 0%, 90% CI: 0% to 53%; P = 0.18) or serious adverse events (placebo, 92%, 90% CI: 68% to 98%; rFVIIa, 82%, 90% CI: 60% to 92%; P = 0.61) were observed between treatment groups. CONCLUSION: The use of a total dose of 400 (200 + 100 + 100) microg/kg rFVIIa in this group of hemodynamically unstable polytrauma patients with TBI was not associated with an increased risk of mortality or with thromboembolic or adverse events.

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