title: Multiple ischemic strokes associated with use of recombinant activated factor VII.
abstract: 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.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Tertiary care medical center.
  
  
  METHODS
  We describe a patient with ischemic stroke who developed hemorrhagic conversion following tissue plasminogen activator administration.
  
  
  METHODS
  Treatment with recombinant activated factor VII, in addition to standard treatment with cryoprecipitate and platelets.
  
  
  METHODS
  Brain imaging showing multiple ischemic strokes.
  
  
  RESULTS
  The patient subsequently developed multiple acute cerebral infarcts in different vascular distributions.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurology, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA. rlibman@lij.edu
authors.forename: Richard B
authors.initials: RB
authors.lastname: Libman
authors.forename: Cordrin
authors.initials: C
authors.lastname: Lungu
authors.forename: Thomas
authors.initials: T
authors.lastname: Kwiatkowski
mesh_terms: D002545:Brain Ischemia / Q000139:chemically induced*; D002543:Cerebral Hemorrhage / Q000188:drug therapy*; D005167:Factor VII / Q000009:adverse effects* / Q000627:therapeutic use; D015942:Factor VIIa; D017809:Fatal Outcome; D006406:Hematoma / Q000188:drug therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D020521:Stroke / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: D011994:Recombinant Proteins; D005167:Factor VII; C103587:recombinant FVIIa; D015942:Factor VIIa