Successful graft patency after factor VIIa use for bleeding in coronary artery surgery: an unusual complication of a coronary artery bypass surgery

There is a growing literature regarding the use of recombinant activated factor VII (rFVIIa) (NovoSeven, NovoNordisk, Copenhagen, Denmark) to control refractory hemorrhage after cardiopulmonary bypass in cardiac surgery. This supporting evidence is mostly documented as case reports on patients, of which only six involve coronary artery grafting. We present our experience of a patient undergoing coronary artery bypass grafting, who suffered an anaphylactic reaction to protamine preventing safe reversal of systemic heparinization. Subsequent management of postoperative bleeding was successfully achieved only after rFVIIa administration.