Summary
Traumatic brain contusions may increase in size over time or may develop at a delay after injury. This may lead to neurological deterioration, long term morbidity or even death. Coagulation disorders after injury can contribute to progression of haemorrhage. Recombinant activated factor VII (rFVIIa) was used in 12 patients with a severe head injury who had no systemic coagulopathy but who were considered to be at risk of progression of their intracranial lesion. Twelve consecutive patients suffering from life-threatening acute head injuries from blunt (3 cases) and penetrating mechanisms were given with rFVIIa, either to prevent the expected development of brain contusion or to assist in bleeding control during surgery. In 11 patients, rFVIIa was given by the attending neurosurgeon. Two of the patients died of their severe penetrating injuries one of whom had severe vasospasm 2 days after administration of rFVIIa. The other 11 patients did not appear to suffer any treatment-related adverse effects. When the drug was given prophylactically to prevent brain resection (6 cases) or to limit the need for widening resection (5 cases), marked control was achieved in seven cases, and a lesser effect was observed in the other 4 cases. We conclude that, in a small and highly individually selected series of patients with severe head injury, the administration of rFVIIa did not lead to adverse effects. Although the majority of patients were considered to be at high risk of progression of their lesions, this occurred in only one. The early use of rFVIIa in head injured patients without systemic coagulopathy may reduce the occurrence of enlargement of contusions, the requirement of further operation, and adverse outcome. Prospective randomised controlled studies are required to investigate this.
Similar content being viewed by others
References
B Brandvold L Levi M Feinsod ED George (1990) ArticleTitlePenetrating craniocerebral injuries in the Israeli involvement in the Lebanese conflict, 1982–1985. Analysis of a less aggressive surgical approach J Neurosurg 72 15–21 Occurrence Handle2403589 Occurrence Handle1:STN:280:DyaK3c%2FpsFGrtg%3D%3D
EF Chang M Meeker MC Holland (2006) ArticleTitleAcute traumatic intraparenchymal hemorrhage: risk factors for progression in the early post-injury period Neurosurgery 58 647–656 Occurrence Handle16575328 Occurrence Handle10.1227/01.NEU.0000197101.68538.E6
RP Dutton M McCunn M Hyder M D’Angelo J O’Connor JR Hess TM Scalea (2004) ArticleTitleFactor VIIa for correction of traumatic coagulopathy J Trauma 57 709–719 Occurrence Handle15514523 Occurrence Handle1:CAS:528:DC%2BD2cXhtVekurnM
R Gerlach G Marquardt H Wissing I Scharrer A Raabe V Seifert (2002) ArticleTitleApplication of recombinant activated factor VII during surgery for giant skull base hemangiopericytoma to achieve safe hemostasis J Neurosurg 96 946–948 Occurrence Handle12005404
F Hulka RJ Mullins EH Frank (1996) ArticleTitleBlunt brain injury activates the coagulation process Arch Surg 131 923–928 Occurrence Handle8790176 Occurrence Handle1:STN:280:DyaK28zot1eisA%3D%3D
M Hoffman DM Monroe HR Roberts (1998) ArticleTitleActivated factor VII activates factors IX and X on the surface of activated platelets: thoughts on the mechanism of action of high-dose activated factor VII Blood Coagul Fibrinolysis 9 IssueIDSuppl 1 S61–S65 Occurrence Handle9819030 Occurrence Handle1:CAS:528:DyaK1cXnsVCisLY%3D
Y Kluger B Riou R Rossaint SB Rizoli KD Boffard PI Choong B Warren M Tillinger (2007) ArticleTitleSafety 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 Crit Care 11 R85 Occurrence Handle17686152 Occurrence Handle10.1186/cc6092
JH Lee NA Martin G Alsina DL McArthur K Zaucha DA Hovda DP Becker (1997) ArticleTitleHemodynamically significant cerebral vasospasm and outcome after head injury: a prospective study J Neurosurg 87 221–233 Occurrence Handle9254085 Occurrence Handle1:STN:280:DyaK2szps1Squg%3D%3D Occurrence Handle10.3171/jns.1997.87.2.0221
SA Mayer NC Brun K Begtrup J Broderick S Davis MN Diringer BE Skolnick T Steiner (2005) ArticleTitleRecombinant activated factor VII intracerebral hemorrhage trial investigators: recombinant activated factor VII for acute intracerebral hemorrhage N Engl J Med 352 777–785 Occurrence Handle15728810 Occurrence Handle10.1056/NEJMoa042991 Occurrence Handle1:CAS:528:DC%2BD2MXhsFCiur0%3D
JD Morenski JD Tobias DF Jimenez (2003) ArticleTitleRecombinant activated factor VII for cerebral injury-induced coagulopathy in pediatric patients. Report of three cases and review of the literature J Neurosurg 98 611–616 Occurrence Handle12650436
M Oertel DF Kelly D McArthur WJ Boscardin TC Glenn JH Lee T Gravori D Obukhov DQ McBride NA Martin (2002) ArticleTitleProgressive hemorrhage after head trauma: predictors and consequences of the evolving injury J Neurosurg 96 109–116 Occurrence Handle11794591
P Park ME Fewel HJ Garton BG Thompson JT Hoff (2003) ArticleTitleRecombinant activated factor VII for the rapid correction of coagulopathy in nonhemophilic neurosurgical patients Neurosurgery 53 34–39 Occurrence Handle12823871 Occurrence Handle10.1227/01.NEU.0000068830.54968.A8
I Scharrer (1999) ArticleTitleRecombinant factor VIIa for patients with inhibitors to factor VIII or IX or factor VII deficiency Haemophilia 5 253–259 Occurrence Handle10469179 Occurrence Handle10.1046/j.1365-2516.1999.00319.x Occurrence Handle1:STN:280:DyaK1MzpvVyrtA%3D%3D
SC Stein GS Young RC Talucci BH Greenbaum SE Ross (1992) ArticleTitleDelayed brain injury after head trauma: significance of coagulopathy Neurosurgery 30 160–165 Occurrence Handle1545882 Occurrence Handle10.1097/00006123-199202000-00002 Occurrence Handle1:STN:280:DyaK387oslShtA%3D%3D
JF Soustiel V Shik (2004) ArticleTitlePosttraumatic basilar artery vasospasm Surg Neurol 62 201–206 Occurrence Handle15336858 Occurrence Handle10.1016/j.surneu.2003.10.037
WY Wong WC Huang R Miller K McGinty JK Whisnant (2000) ArticleTitleClinical effect and recovery levels of recombinant FVIIa (NovoSeven) in the treatment of intracranial haemorrhage in severe neonatal FVII deficiency Haemophilia 6 50–54 Occurrence Handle10632743 Occurrence Handle10.1046/j.1365-2516.2000.00345.x Occurrence Handle1:STN:280:DC%2BD3c%2FpvV2jug%3D%3D
Author information
Authors and Affiliations
Corresponding author
Additional information
Correspondence: L. Levi, Ramban Medical Centre, POB 9602, Haifa 31096, Israel.
Rights and permissions
About this article
Cite this article
Zaaroor, M., Soustiel, J., Brenner, B. et al. Administration off label of recombinant factor-VIIa (rFVIIa) to patients with blunt or penetrating brain injury without coagulopathy. Acta Neurochir (Wien) 150, 663–668 (2008). https://doi.org/10.1007/s00701-008-1593-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-008-1593-y