A critical appraisal of the use of recombinant factor VIIa in acquired bleeding conditions.

Recombinant activated factor VII (rVIIa) was initially used for the treatment of inhibitors in patients with haemophilia. However, its localised mode of action at sites of damage to the vessel combined with dramatic clinical observations in exsanguinating patients have resulted in huge interest in its use as a global haemostatic agent. Although it appears safe, with no obvious excess of thrombotic events, its use in assorted acquired bleeding disorders, especially those associated with the development of complex coagulopathies, such as in the post-trauma state, has proved to be less dramatic than hoped.