A 30-year-old man bled massively from a stab wound that injured his liver and right kidney and entered a life-threatening cycle of transfusion, hypothermia, coagulopathy, and rebleeding in spite of surgery and aggressive resuscitation. He was given a single dose of recombinant activated factor VII (rVIIa; NovoSeven, Novo Nordisk, Denmark) in a final attempt to save his life. The patient responded favorably, as bleeding stopped almost immediately and coagulation markers became normal. Clinical course following rVIIa administration was good. Severe bleeding in the trauma patient needing massive transfusion can become complicated by dilutional coagulopathy and hypothermia. Therapy with rVIIa is a promising aid to controlling bleeding in the repeatedly transfused patient who does not respond to standard replacement of blood products.