Pulmonary haemorrhage associated with myocardial infarction thrombolysis is an unusual complication; in 1996, Chang YC et al published a retrospective study, finding an incidence of 0.4% [11] . The same is true of platelet antiaggregation treatment, where isolated cases of DAH have been described [12] . In spite of its low incidence, DAH secondary to acute coronary syndrome treatment is a complication which maybe undetected, due to the common radiological findings in both DAH and ALI/ARDS and acute pulmonary oedema [13] . Bearing in mind the thrombogenic risk of a systemic administration of local rFVIIa, and with Heslet et al's publication as a reference, in which 6 consecutive critically ill patients with acute DAH are treated with local rFVIIa, intrapulmonary administration of the drug was chosen in the cases here presented with a view to avoiding the risk of thrombosis of the arteriovenous fistula in the first case, and of reinfarction in the second [4, 10] .