Recombinant
activated Factor VII (
rFVIIa) has been successfully used in the treatment of
haemophilia A and B with associated inhibitors for some years.
Activated Factor VII binds to activated platelets independently of
tissue factor. The resulting stimulation of an exaggerated early
thrombin burst at sites of
vascular injury makes it an attractive potential treatment for massive, uncontrolled
bleeding associated with surgery and
trauma. This article describes the evidence relating to surgery and
trauma. The lack of large, controlled trials of
rFVIIa means that a definitive recommendation regarding its use cannot be made at present. However, in the context of clearly defined protocols and balanced treatment strategies,
rFVIIa may have a role in traumatic
bleeding. Large scale, randomised controlled trials in
trauma are required, as is further work on the safety profile of
rFVIIa with an independent international safety monitoring committee.