Is Recombinant Activated Factor VII a Universal Hemostatic

Advances in resuscitation, surgical, anesthetic, and critical care management have significantly improved outcomes after trauma or major surgery in the past two decades. However, morbidity and mortality still occur due to a wide variety of complications in the setting of trauma and major surgery. One of the foremost of these complications is continued blood loss [1, 2]. Despite best surgical practice ongoing bleeding from sites of major trauma and surgery frequently occurs due to coagulopathy [3, 4]. With laboratory testing, some of the deficits in the coagulation process can be identified and with blood bank supplies patients’ hemoglobin concentrations can be maintained and some deficits in the pathways of blood coagulation can be rectified. However, our understanding of coagulation processes is still incomplete and our ability to intervene in the setting of inadequate coagulation is limited. Furthermore, the use of large volumes of blood bank supplies, in the setting of ongoing major hemorrhage, carries its own list of complications, in particular ongoing organ damage and iatrogenic infection. Taking a broader view of the provision of health care in the context of limited resources, increasing demand for blood bank components makes ever increasing inroads into scarce supplies.