Bleeding associated with acquired factor V inhibitor in a patient on warfarin treated successfully with prednisolone

Khalafallah, Alhossain A; Grabek, Julian; Hayes, Robert C.; Mohamed, Muhajir

doi:10.1136/bcr-2013-010018

Cited by 6 publications

(3 citation statements)

References 10 publications

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“…Although the mechanisms of drug-induced antibody production remain unclear, reactive autoantibodies may underlie the development of AiFVD in our patient. Acquiring factor V inhibitor after administration of warfarin and dabigatran as well as antimicrobial agents were also reported [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Acquired factor V inhibitor with erythema and eosinophilia in a patient with end-stage renal disease

et al. 2022

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Autoimmune factor V deficiency (AiFVD) is a rare bleeding disorder caused by factor V inhibitors. In this report, we present the case of an 89-year-old man who developed bleeding tendency during surgery to create arteriovenous fistula for hemodialysis. The bleeding tendency developed with prolongation of activated partial thromboplastin and prothrombin time, following drug-induced eruption and eosinophilia. Significant reduction in coagulation factor activity and inhibitory pattern in cross-mixing tests suggested the presence of inhibitors to coagulation factors. Subsequently, we detected a factor V inhibitor and anti-factor V autoantibodies was confirmed using enzyme-linked immunosorbent assay with purified human plasma factor V. Thus, the patient was ‘definitely diagnosed’ with AiFVD in accordance with the diagnostic criteria enacted by the Japanese Ministry of Health, Labor, and Welfare. The bleeding tendency improved after initiating oral prednisolone 50 mg (1 mg/kg) followed by normalization of activated partial thromboplastin time and prothrombin time at the 34th day. After improving the coagulation system prolongation, the inhibitor and autoantibodies has been eradicated. Since it is suggested that drug-induced immune response can cause AiFVD, AiFVD should be considered in patients who undergo hemodialysis and develop failure of hemostasis and drug-induced eruption.

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Section: Discussionmentioning

confidence: 99%

Acquired factor V inhibitor with erythema and eosinophilia in a patient with end-stage renal disease

et al. 2022

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“…However, it is difficult to establish whether these latter conditions play a causative role in the development of the inhibitor because concomitant antibiotic therapy was also present in almost all cases ( 2 ). Cases of an acquired factor V inhibitor due to medications, such as rifaximin, dabigatran etexilate methanesulfonate and warfarin have been described ( 1 , 4 , 5 ). However, our patient's medications, except for furosemide and cefcapene pivoxil hydrochloride hydrate, had been continually taken for many years without developing any inhibitors.…”

Section: Discussionmentioning

confidence: 99%

Acquired Factor V Inhibitor

et al. 2016

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Inhibitors directed against factor V rarely occur, and the clinical symptoms vary. We herein report the case of a patient who presented with a decreased factor V activity that had decreased to <3 %. We administered vitamin K and 6 units of fresh frozen plasma, but she thereafter developed an intracerebral hemorrhage. It is unclear whether surgery >10 years earlier might have caused the development of a factor V inhibitor. The treatment of acquired factor V inhibitors is mainly the transfusion of platelet concentrates and corticosteroids. Both early detection and the early initiation of the treatment of factor V inhibitor are thus considered to be important.

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“…Our patient's persistently abnormal coagulation studies despite discontinuation and reversal of warfarin raised the possibility of an acquired FV inhibitor, although she had received human thrombin only on this hospitalization . While the APTT did correct with normal plasma, its value was in the upper range of normal: 35.9 s (normal 27.5 – 36.5 s).…”

Section: Discussionmentioning

confidence: 99%

Acquired factor V inhibitor after exposure to topical human thrombin related to an otorhinolaryngological procedure

Donohoe

Levine

2015

Journal of Thrombosis and Haemostasis

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To cite this article: Donohoe K, Levine R. Acquired factor V inhibitor after exposure to topical human thrombin related to an otorhinolaryngological procedure. J Thromb Haemost 2015; 13: 1787-9.Summary. Acquired factor V (FV) inhibitors occur rarely and classically develop after exposure to bovine thrombin. The clinical presentation is variable, ranging from asymptomatic with incidental laboratory abnormalities to significant bleeding. With the development of human-derived thrombin agents, bovine thrombin is less frequently used. We report a case of an acquired FV inhibitor that developed in a patient after exposure to human thrombin used as a hemostatic agent during an otorhinolaryngology surgical procedure. Our review of the literature revealed only one prior reported case of FV inhibitor after exposure to human thrombin. Hematologists and surgeons should be aware of this rare, but potentially life-threatening, complication in the postprocedural setting.

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Bleeding associated with acquired factor V inhibitor in a patient on warfarin treated successfully with prednisolone

Cited by 6 publications

References 10 publications

Acquired factor V inhibitor with erythema and eosinophilia in a patient with end-stage renal disease

Acquired factor V inhibitor with erythema and eosinophilia in a patient with end-stage renal disease

Acquired Factor V Inhibitor

Acquired factor V inhibitor after exposure to topical human thrombin related to an otorhinolaryngological procedure

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