Recombinant Factor VIIa. It is amazing for Factor VII deficiency. It hasn’t got much evidence for anything else, and increases the risk of arterial thrombosis. It’s not the done thing anymore except when all else has completely failed.

To quote from NICE guidance on upper GI bleeds:

Transfuse patients with massive bleeding with blood, platelets and clotting factors in line with local protocols for managing massive bleeding.

Base decisions on blood transfusion on the full clinical picture, recognising that over-transfusion may be as damaging as under-transfusion.

Do not offer platelet transfusion to patients who are not actively bleeding and are haemodynamically stable.

Offer platelet transfusion to patients who are actively bleeding and have a platelet count of less than 50 x 10⁹/litre.

Offer fresh frozen plasma to patients who are actively bleeding and have a prothrombin time (or international normalised ratio) or activated partial thromboplastin time greater than 1.5 times normal. If a patient’s fibrinogen level remains less than 1.5 g/litre despite fresh frozen plasma use, offer cryoprecipitate as well.

Offer prothrombin complex concentrate to patients who are taking warfarin and actively bleeding.

Note this patient actually had an upper GI bleed (recent onset black stools, with dropping Hb and rising urea in a patient on warfarin). You need to fluid resus, crossmatch 4-6 units usually, reverse any anticoagulation and For the purpose of this schedule below on how to reverse warfarin, major bleeds means any bleeds that are life or limb threatening, especially GI bleeds, intracranial bleeds and haemarthrosis.

• Major bleeding—stop warfarin sodium; give phytomenadione(vitamin K₁) by slow intravenous injection; give dried prothrombin complex (factors II, VII, IX, and X); if dried prothrombin complex unavailable, fresh frozen plasma can be given but is less effective; recombinant factor VIIa is not recommended for emergency anticoagulation reversal
• INR >8.0, minor bleeding—stop warfarin sodium; give phytomenadione(vitamin K₁) by slow intravenous injection; repeat dose of phytomenadione if INR still too high after 24 hours; restart warfarin sodium when INR <5.0
• INR >8.0, no bleeding—stop warfarin sodium; give phytomenadione(vitamin K₁) by mouth using the intravenous preparation orally [unlicensed use]; repeat dose of phytomenadione if INR still too high after 24 hours; restart warfarin when INR <5.0
• INR 5.0–8.0, minor bleeding—stop warfarin sodium; give phytomenadione(vitamin K₁) by slow intravenous injection; restart warfarin sodium when INR <5.0
• INR 5.0–8.0, no bleeding—withhold 1 or 2 doses of warfarin sodium and reduce subsequent maintenance dose