There is a range of pharmacological interventions available to reduce blood loss and minimize or avoid the use of allogeneic blood transfusions . These agents include the protease inhibitor aprotinin (TrasylolA? Aprotinin Bayer AG, Bayerwerk, Leverkusen, Germany), lysine analogue antifibrinolytics [tranexamic acid (CyclokapronA? Tranexamic Acid Pfizer Inc., New York, NY, USA) and epsilon aminocaproic acid (AmicarA? Xanodyne Pharmaceuticals, Inc., New York, KY, USA)], DDAVP (DesmopressinA? Raybiotech, Inc., Narcross, GA, USA) and recombinant factor VIIa (rFVIIa; NovoSevenA? Novo Nordisk A/S, Bagsv? rd, Germany). This article will focus on the current role for rVIIa in controlling haemorrhage in the non-haemophiliac setting. rFVIIa is being widely used off-label and there is considerable controversy as to its benefits and risks. Recombinant activated factor VII is effective for the prevention or treatment of bleeding in patients with inhibitors to factor VIII (FVII) and factor IX. rFVIIa is licenced in many countries for this indication and is also licenced in some markets for Glanzmanna??s thrombasthenia and congenital FVII deficiency. It has been extensively used among haemophiliacs and enhances clotting at the site of bleeding through the formation of a thrombin burst and a stable fibrin clot. Recent insights into haemostatic mechanisms have resulted in a better understanding of the central role of FVII/FVIIa in the localizing and initiating of haemostasis. Consequently, this has led to the wider use of rFVIIa as a haemostatic agent.