Activated Factor Seven (aFVII) versus Aminocaproic Acid for Treatment of Traumatic Retro-Peritoneal Hematoma

Abstract

Introduction: Off-labelled use of activated Factor VII (aFVII) in severe traumatic bleeding has been used as an alternative to aminocaproic. Aim of Work: The aim of this study is to compare the efficacy of aFVII with aminocaproic acid in the medical treatment of retroperitoneal bleeding, treatment of hypovolemic shock and preventing complications of massive blood transfusion. Materials and Methods: 80 patients with traumatic retro-peritoneal hematoma were allocated into two groups of 40 patients each. Patients in Group A received aminocaproic acid, while patients of group B received aFVII. The number of packed RBCs given to achieve the target Hb level and time to get to this target Hb level (>10 gm%) were recorded as indicators of control bleeding. Blood pressure, pulse, arterial blood gasses and urine output were recorded as indicators of successful treatment of hypovolemic shock. Hypoxic index, chest X-ray and coagulation profile were used as indicators for complications. Results: There was a significantly smaller number of packed RBCs given to patients of group B to achieve the target Hb level and this target Hb level was achieved in a shorter time. There was a significantly higher number of patients in group B compared to group A who had normal blood pressure, pulse and urine output, pH and bicarbonate concentration. There was a significantly smaller number of patients who developed DIC and TRALI in group B compared to group A. Conclusion: aFVII was more effective than aminocaproic acid and needed a shorter time to stop retroperitoneal bleeding, treat hypovolemic shock, restore adequate tissue perfusion and protect patients from complications of massive blood transfusion.