Recombinant activated factor VII (rFVIIa) (NovoSeven) is a novel hemostatic agent originally developed to treat bleeding episodes in hemophilic patients with inhibitors against coagulation factors VIII and IX. In recent years, rFVIIa has also been employed for the management of uncontrolled bleeding in a number of congenital and acquired hemostatic abnormalities. Based on a literature search in...

BACKGROUND Uncontrolled bleeding leads to 40-86% of preventable deaths due to trauma. Use of NovoSeven (rFVIIa) in trauma is promising, although data supporting its utilization are limited. CASE REPORT We report the case of a patient who sustained a penetrating grade V cardiac injury (AAST-OIS) and presented postoperative massive coagulopathic bleeding arrested by the administration of platel...

Hereditary hemorrhagic telangiectasia (HHT) is a genetic disorder characterized by uncontrolled multisystem angiogenesis with epistaxis, gastrointestinal bleeding, iron-deficiency anemia, and arteriovenous malformations, and is often associated with increased levels of vascular endothelial growth factor (VEGF). Bevacizumab, a VEGF inhibitor, reduces epistaxis, telangiectasias, and iron-deficien...

We present a case of an 87-year-old female who was evaluated for an 8.5 cm left sided renal mass concerning for malignancy. The patient was transiently thrombocytopenic over the previous 4 months with platelet counts ranging from 50,000 to 125,000 plt/mcL and experienced diffuse hemorrhage during radical nephrectomy with failure to achieve mechanical hemostasis or fulguration. Following Surgice...

OBJECTIVE Uncontrolled hemorrhagic shock is a significant factor in death of severe multiple trauma patients. The acute management of injured bleeding in emergency department (ED) may improve patient outcomes. The medical records of severe multiple trauma patients with hemorrhagic shock in our ED were reviewed to summarize an evidence-based approach to the management of critically injured bleed...

UNLABELLED In a porcine model of uncontrolled hemorrhagic shock, we evaluated the effects of vasopressin versus an equal volume of saline placebo versus fluid resuscitation on hemodynamic variables and short-term survival. Twenty-one anesthetized pigs were subjected to severe liver injury. When mean arterial blood pressure was <20 mm Hg and heart rate decreased, pigs randomly received either va...

Controversy continues as to whether uncontrolled or controlled hemorrhage is the most appropriate for the study of hemorrhagic shock and resuscitation. To appraise differences between these models, we evaluated the relationship between blood volume loss and blood pressure in controlled versus uncontrolled hemorrhage. Anesthetized, instrumented, immature female pigs (40 kg) were assigned to one ...

During a 10 year study period 234 patients were admitted on 371 occasions with a total of 566 acute variceal bleeding episodes. Of these, 173 patients had 343 variceal bleeds which required balloon tamponade to achieve initial control of bleeding during 229 admissions and were then referred for emergency injection sclerotherapy. Sixty-eight percent of these patients had alcoholic cirrhosis and ...

n engl j med 369;11 nejm.org september 12, 2013 1080 anticoagulants may prevent warfarin-induced skin necrosis but cannot be recommended yet. Finally, in reply to Grzybowski and Ascaso: the use of antithrombotic agents in ocular surgery remains highly controversial. The stated bleeding rate of 3% is excessive in modern cataract surgery. This avascular procedure, which is frequently performed wi...

The paper describe the use of rFVIIa in the management of massive bleeding in a patient with polytrauma involving liver injury. An 18-year-old girl with severe polytrauma sustained during a bus-car collision. She had multiple musculoskeletal injuries, severe concussion of the liver with amputation of the left liver lobe, disruption of the left hepatic vein from the inferior vena cava, and impai...