Factor V Deficiency and Mechanical Valve Replacement: Challenges in Perioperative Hemostasis and Anticoagulation.
Daniel Idoate Domench, Robin Reid, Dua Azim et al.
✦ AI-curated · Sources linked
Case in brief
A 30-year-old woman with congenital factor V deficiency (baseline activity 18%) underwent mechanical aortic valve replacement and mitral valve repair due to infective endocarditis. Preoperative fresh frozen plasma (FFP) was administered to achieve a factor V level >20%. Despite low postoperative factor V levels (<20%), she had minimal bleeding complications, including transient anemia and one episode of gross hematuria requiring platelet transfusion.
What made this case unusual
The patient's relatively mild bleeding phenotype, despite low factor V levels, was attributed to her heterozygosity for factor V Leiden and a prekallikrein variant.
Diagnostic / clinical pearl
Clinicians should recognize that laboratory values may not always correlate with clinical bleeding risk, necessitating individualized perioperative management in patients with bleeding disorders.
Why it matters
This case underscores the complexities of anticoagulation management in patients with rare bleeding disorders undergoing high-risk surgeries.