Recombinant activated factor VII (rVIIa) has been used off-label to control bleeding after lung transplantation; however, the thromboembolic risks remain unclear. To address this issue, we analyzed the effects of rVIIa use on the incidence of venous thromboembolic events (VTE).We conducted a retrospective cohort study evaluating all patients that received lung transplantation between August 1, 2008 and October 31, 2012. Data was extracted using the Organ Transplant Tracking Record (OTTR), inpatient admission and discharge summaries, laboratory reports, and clinic notes. The incidence of VTE was compared between patients receiving rVIIa and those that did not (controls). Between-group comparisons were made using the chi-squared test for categorical data, and the Mann-Whitney U test for continuous data.Among 255 patients, 63 (24.7%) developed a new VTE after transplantation. Within this group, 15 (5.9%) experienced a pulmonary embolism (PE). A total of 32 patients (12.5%) received 43 doses of rVIIa [median total dose = 4.9 mg (range 2-15)]. Intraoperative administration of rFVIIa was more common than cardiothoracic intensive care unit administration (59.4% vs. 40.6%). Overall, patients receiving rFVIIa had higher rates of VTE than controls [14 (43.8%) vs. 49 (22.0%), p<0.01)]. Rates of DVT (40.6% vs. 19.7%, p<0.01) and PE (12.5% vs. 4.9%, p=0.103) were both higher in rVIIa treated patients; however, the incidence of PE did not differ significantly. Cumulative VTE rates between rVIIa and controls analyzed at 30, 60, and 90 days following transplantation were 21.9% vs. 11.2% (p=0.09), 28.1% vs. 15.7% (p=0.08), and 34.4% vs. 17.9% (p = 0.03), respectively. Median time to first event was similar (27 vs. 23 days, p=NS). No thromboembolic event resulted in patient death.VTE is a frequent complication after lung transplantation. In our cohort of lung transplant recipients, treatment with rFVIIa significantly increased the risk of venous thromboembolic events.