Journal Club
May 2010 Emergency Medicine Journal Club Vignette

You receive a phone call from an outside hospital about a patient they want to transfer to see a neurosurgeon. The patient is a 70 year old male who fell, hit his head and now has a subdural hematoma with a small amount of subarachnoid hemorrhage. The patient is on Coumadin and has an INR of 8. The referring physician states that your neurosurgeon wants him to be seen in the ED first. The referring doctor has given the patient Vitamin K. The FFP has been ordered and is thawing. They do not have Prothrombin Complex Concentrate at the referring facility but they do have Factor VII. He has never given it before and asks you whether or not you want him to give Factor VII or not as it is a 90-120 minute transport time. You know that your facility uses PCC but are not sure about the literature for or against the use of Factor VII.

To investigate this, the following approach is explored:

PICO Question

Population: Adults on Coumadin with ICH
Intervention: Factor VII
Comparison: Placebo
Outcome: Death, Neurological Disability, Hematoma Size


Search Strategy: Pubmed; Keywords: intracerebral hemorrhage AND factor VII
First years: Efficacy and safety of recombinant activated factor VII for acute intracerebral hemorrhage. Mayer et al. (Pub Med Link) NEJM May 15, 2008.

Presenters: Dr. Chan, Dr. Miller

Article critique
Second years: Thromboembolic events with recombinant activated factor VII in spontaneous intracerebral hemorrhage: results from the Factor Seven for Acute Hemorrhagic Stroke (FAST) trial Diringer et al. (Pub Med Link) Stroke January 2010.

Presenter: Dr. Colling

Article critique
Third years: A meta-analysis of the efficacy and safety of recombinant activated factor VII for patients with acute intracerebral hemorrhage without hemophilia. Yuan et al. (Pub Med Link) Journal of Clinical Neuroscience June 2010.

Presenters: Dr. Bachmann, Dr. A. Robinson

Article critique
1st years use the "RCT Critical Review Form" (Download)
2nd years use the "Harm Critical Review Form" (Download)
3rd years use the "Meta-Analysis Review Form" (Download)
© Ohio State University Department of Emergency Medicine