Recombinant factor VIIa fails to correct coagulopathy induced by haemodilution with colloid.

Editor—In recent years, numerous single case reports and a few series of retrospective cohorts of patients have been published dealing with serious bleeding and massive transfusion demands in whom recombinant activated factor VII concentrate (rFVIIa) has been tried as salvage therapy. In the absence of controlled clinical studies, practice has arisen in many places where rFVIIa has been adopted as part of the haemostasis armamentarium for treatment of uncontrollable bleeding after trauma and surgery. We presented data recently in the British Journal of Anaesthesia that illustrate a hypocoagulable state of blood after exposure to haemodilution with various colloid plasma expanders, and our experiments point to a relatively beneficial change in the dynamic whole blood clotting profile if such blood is substituted with fibrinogen concentrate. More recently, Brummel-Ziedins and colleagues have supplemented our findings by demonstrating that haemodilution with colloids causes diminished platelet