Why the study?
Does recombinant factor VIIa improve outcomes in patients requiring acute reversal of warfarin due to severe bleeding?
Does recombinant factor VIIa improve outcomes in patients requiring acute reversal of warfarin due to severe bleeding?
The abstract presents a clinical vignette to prompt a review of the evidence for using recombinant factor VIIa in the acute reversal of warfarin during severe bleeding.
Answers are grounded in this paper and cite their sources.
Vignette-driven review underscores limited evidence for rFVIIa in warfarin reversal; leaves open optimal strategies in severe bleeding.
A 47-year-old man presents with hypovolemic shock. He takes warfarin as a result of a mechanical mitral valve insertion 5 years prior, his INR at presentation is 8.4 and emergent CT reveals a very large retroperitoneal hematoma. Despite aggressive fluid and transfusion support he continues hypotensive, requiring ionotrope support. You are asked if he should receive recombinant factor VIIa.
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Rosovsky et al. (2008) studied this question.
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