Recombinant factor VIIa as an adjunct in nonoperative management of solid organ injuries in children Laura R. Vick, Saleem Islam ⁎ Division of Pediatric Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, MS 39216, USA Received 29 August 2007; accepted 2 September 2007 Index words: Blunt abdominal trauma; Recombinant factor VIIa; Pediatric trauma, nonoperative trauma Abstract Background: Ongoing bleeding after blunt solid organ injury in children may require invasive therapy in the form of either angiographic or operative control. We report our experience in the use of a procoagulant, recombinant activated factor VII (rFVIIa), for controlling persistent bleeding in blunt abdominal trauma in children. Methods: After institutional review board approval, the records of 8 children with blunt abdominal trauma, persistent bleeding, and managed nonoperatively with rFVIIa were reviewed. Results: All 8 patients presented to our institution after sustaining blunt abdominal trauma and solid organ injury. All children had evidence of persistent bleeding with a drop in hematocrit and elevation in heart rate. Patients received a single dose of rFVIIa at 75 to 90 μg/kg (1 patient had 24 μg/kg) and had successful control of their bleeding without any further therapeutic intervention. Only 3 patients required a blood transfusion after rFVIIa administration—2 who had subarachnoid hemorrhages and the third during pelvic fixation. There were no cases of thromboembolic events after treatment with rFVIIa. Conclusions: Recombinant factor VIIa is a useful adjunctive therapy in pediatric patients with evidence of ongoing hemorrhage from blunt abdominal injury and may reduce the need for invasive therapeutic procedures and transfusions. © 2008 Elsevier Inc. All rights reserved. Solid organ injury in the pediatric population leading to severe and ongoing hemorrhage can have devastating consequences, including death if not controlled. The manage- ment of solid organ injury from trauma in children has evolved over the past few decades as imaging and monitoring modalities have improved. Nonoperative management of intraabdominal organ injuries after trauma is now the gold standard [1]. However, there is a group of patients in which the hemorrhage from the injury continues and in whom adjunctive treatments are needed. Typically, these treatments include angioembolization techniques in interventional radiology [2] or operative control of the bleeding. Recently, a hemostatic agent known as recombinant activated factor VII (rFVIIa) has been used as a noninvasive therapy for continued bleeding in the adult trauma literature [3-10] and has only been seen in a few cases of pediatric trauma [11,12]. Recombinant activated factor VII is a product that was approved by the US Food and Drug Administration in 1999 for use in bleeding episodes in patients with hemophilia A or B and as inhibitors to factors VIII or IX [13]. This product is nearly identical to human factor VIIa structurally and promotes Presented at the 38th annual meeting of the American Pediatric Surgical Association, Orlando, Florida, May 24-27, 2007. ⁎ Corresponding author. Division of Pediatric Surgery, Department of Surgery, University of Florida College of Medicine, PO Box 100286, Gainesville, FL 32610-0286, USA. Tel.: +1 352 392 3718; fax: +1 352 392 9081. E-mail address: islamsa@surgery.ufl.edu (S. Islam). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2007.09.044 Journal of Pediatric Surgery (2008) 43, 195–199