ProCon Debate Does recombinant factor VIIa have a role to play in the treatment of patients with acute nontraumatic hemorrhage 英文参考文献.docVIP

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ProCon Debate Does recombinant factor VIIa have a role to play in the treatment of patients with acute nontraumatic hemorrhage 英文参考文献.doc

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ProCon Debate Does recombinant factor VIIa have a role to play in the treatment of patients with acute nontraumatic hemorrhage 英文参考文献

Available online /content/10/3/214 Review Pro/Con Debate: Does recombinant factor VIIa have a role to play in the treatment of patients with acute nontraumatic hemorrhage? Paola Pieri1, Deborah M Stein1, Sandro Scarpelini2 and Sandro Rizoli3 1Division of Critical Care/Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA 2Trauma and Emergency Surgery, Faculty of Medicine of Ribeir?o Preto, University of Sao Paulo, Brazil 3Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada Corresponding author: Sandro Rizoli, sandro.rizoli@sw.ca Published: 1 June 2006 Critical Care 2006, 10:214 (doi:10.1186/cc4940) This article is online at /content/10/3/214 ? 2006 BioMed Central Ltd Abstract The scenario A 49-year-old male has been managed in the intensive care unit for 5 days after a large left diaphragmatic hernia repair and is currently being weaned from mechanical ventilation. He suddenly has significant hematemesis and becomes hemodynamically unstable, with alteration to his coagulation. You start to resuscitate him with fluid, blood and plasma, in order to reverse the hemorrhagic shock and correct the coagulopathy. An endoscopy reveals diffuse gastric erosions but fails to stop the bleeding. He continues to be unstable and surgical intervention is not an option. You are aware that Perhaps it is not surprising that in the critical care environment, where lives are frequently on the line, off-label use of certain drugs is relatively common. In general, there are two camps of opinion on this type of utilization. One camp would suggest that potentially life saving products cannot ethically be withheld from patients who may benefit. The other camp would counter that it is inappropriate to administer products if the risk/benefit ratio has not been clearly defined in clinical trials. Off-label use of factor