This case report describes a fatal outcome after application of rFVIIa in combination with PCC in a bleeding patient after heart transplantation treated with ECMO. The patient was in desperate condition and suffered from a Candida sepsis, which was unrecognized preoperatively. Sepsis is a highly prothrombotic state. Several case reports report on thromboembolic complications with respect to rFVIIa and even controlled studies have reported these adverse events. Often, rFVIIa is a desperate, back-to-the-wall treatment. Thus, controlled trials are difficult or impossible to perform. However, the present case report is yet another warning to use rFVIIa cautiously in cardiac surgery.

– Wulf Dietrich