Patients with prolonged severe cardiogenic shock requiring implantation of a biventricular assist device may develop diffuse bleeding due to alteration of hepatic and renal function and subsequent coagulopathy. Bleeding control in these patients may be difficult despite massive use of blood products. We report on the successful use of recombinant activated factor VII for control of massive bleeding after implantation of a biventricular assist device in a patient with prolonged severe cardiogenic shock.