Multiple ischemic strokes associated with use of recombinant activated factor VII.

BACKGROUND Intracerebral hemorrhage is associated with a high rate of mortality and functional disability. For most patients, no treatment other than supportive care has been shown to improve outcome. Preliminary studies suggest that recombinant activated factor VII may limit early hematoma growth and improve functional outcome. However, ischemic complications may occur in some patients. OBJECTIVE To report a case of severe cerebral ischemic complications associated with the use of recombinant activated factor VII. DESIGN Case report. SETTING Tertiary care medical center. PATIENT We describe a patient with ischemic stroke who developed hemorrhagic conversion following tissue plasminogen activator administration. INTERVENTIONS Treatment with recombinant activated factor VII, in addition to standard treatment with cryoprecipitate and platelets. MAIN OUTCOME MEASURE Brain imaging showing multiple ischemic strokes. RESULTS The patient subsequently developed multiple acute cerebral infarcts in different vascular distributions. CONCLUSION Although the exact relationship between treatment with recombinant activated factor VII and the development of multiple ischemic strokes remains uncertain, this case suggests that a cautious approach to treatment with this agent is warranted until more data are available.