Massive pulmonary embolism with concomitant intracranial haemorrhage is a condition associated with high mortality. Emergency embolectomy is indicated in those cases in which medical treatment is not possible. The case of a 65-year-old woman with massive pulmonary embolism after cranial trauma with intracranial haemorrhage and two cardiac arrests prior to surgery is described. The patient suffered a right ventricular failure requiring 6 h of extracorporeal circulation. After surgery a bleeding disorder happened despite conventional treatment. The patient was transferred to the ICU with packing. Despite the recent thrombotic event recombinant activated Factor VII (70 μg/kg) was used and the bleeding controlled. No other complications occurred and she was discharged 1 month later. As far as we know this is the first time that recombinant activated Factor VII has been used after a massive pulmonary embolism.