Factor concentrates including recombinate activated factor VII (rFVIIa), three and four factor prothrombin concentrates and fibrinogen concentrates may be used in massive transfusion events. The use of some of these concentrates in massive transfusion may be considered "off-label" as the product circular does not include this indication.
One major concern with the use of these drugs is the unintentional intravascular clotting leading to stroke. There may be cautions specific to a drug such as the contraindication for patients with acquired defective color vision, since this prohibits measuring one endpoint that should be followed as a measure of toxicity.
Cryoprecipitate and other agents incorporating thrombin or fibrin may be used topically at the point of bleeding to stop or reduce bleeding.
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