Novoseven for OR

[hughes]

Does anybody issue NovoSeven for the OR in emergent cases for patients on Coumadin?

Thanks,

VH

[clmergen]

We use a lot of NovoSeven for our heart and trauma cases but NEVER for the reversal of Coumadin.

[hughes]

Would you be able to differentiate your OR patients that are on Coumadin, in other words regardless of the trauma, you would never give NovoSeven if you knew they were on Coumadin in an OR bleeding situation?

[clmergen]

We wouldn't know if they are on coumadin or not, but so many of our traumas are young males so we assume not. If NovoSeven was requested for coumadin reversal, then the request would be forwarded to our Medical Director for appropriateness. But every order has to have approval from the Medical Director or another clinical pathologist except what we give in support of our Massive Transfusion Protocol. For MTP, we contact a MD or CP if they request beyond what is written in the protocol.

[hughes]

Your medical director would likely refuse issue of Novoseven in a trauma situation if they knew the patient was on Coumadin, since they have to approve it, I can only think they have to look at patient meds before approval.

[clmergen]

In trauma situations, the physicians don't always know what meds the patients are on so we don't even concern ourselves with that. And NovoSeven is usually given after the patient has had several rounds of RBC/FP/PLT infusions so coumadin effect is pretty much a moot point. It is a rare moment when we refuse to give NovoSeven and it would have to be an agreement between our pathologist and the attending physician.