An end-stage renal failure patient with lupus nephritis was treated with low molecular weight heparin (LMWH) and aspirin for cardiac ischemia. She was then subjected to surgery to recreate a new arteriovenous fistula for dialysis 1 day after discontinuing LMWH and aspirin. Severe postsurgical bleeding required wound reexploration and multiple transfusions of blood products, which nevertheless, failed to arrest bleeding. Recombinant factor VIIa (rFVIIa) as a bolus dose of 120 microg/kg successfully secured hemostasis. Bleeding in this patient was attributed to the accumulation of low molecular weight heparin activity from poor renal clearance as well as the antiplatelet activity of aspirin. The potential of rFVIIa in securing hemostasis for excessive bleeding after use of these agents is promising.