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Richard B. Libman, MD; Cordrin Lungu, MD; Thomas Kwiatkowski, MD

Arch Neurol. 2007;64(6):879-881.

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.

Author Affiliations: Department of Neurology (Dr Libman) and Department of Emergency Medicine (Dr Kwiatkowski), Long Island Jewish Medical Center, and Department of Neurology (Dr Lungu), North Shore Long Island Jewish Health System, New Hyde Park, NY.

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