Recombinant activated factor VII in refractory gastrointestinal haemorrhage of unknown aetiology.

We report a 27-year-old patient who suffered severe gastrointestinal (GI) bleeding of unknown aetiology after undergoing elective abdominal surgery to remove a colonic tumour. Although the immediate postoperative recovery period was uneventful, rectal bleeding and signs of haemorrhagic shock developed within 10 hours of surgery. Nasogastric aspiration and laparotomy failed to reveal the cause of the GI haemorrhage, and the patient remained unresponsive to conventional haemostatic therapy. Treatment with a single dose of recombinant activated factor VII (rFVIIa) 45 microg/kg led to reduced bleeding, improvements in haemodynamic status, and reduced transfusion requirements. Although further investigation is warranted, our findings suggest that rFVIla may be useful in the rescue treatment of severe GI haemorrhage of unknown origin (Tab. 1, Ref. 17).