Acquired Factor V Inhibitor Developing after Treatment with Dabigatran Etexilate Methanesulfonate: A Case Report and Review of the Literature

Abstract

A 90-year-old man presented with subcutaneous ecchymoses. He had been under treatment with dabigatran etexilate methanesulfonate (DEM). Prolonged APTT and decreased PT was developed 2 months after the start of DEM, more prolonged 6 months later. DEM was discontinued, the coagulopathy did not improve. Factor V activity was decreased, along with appearance of coagulation factor V inhibitor (FVI). He did not have antiphospholipid syndrome or malignancy. He was diagnosed as having acquired FVI caused by DEM. Steroid pulse therapy was effective. There have been 74 reported cases of AFVI induced by drug treatment, but none after treatment with DEM.

A rare case of acquired factor V inhibitor, during treatment with dabigatran for chronic atrial fibrillation, successfully treated with bypassing agents

“…However, given the common presence of the above‐mentioned conditions and medications in the general population, alone or in association, it is difficult to prove the relationship with the inhibitor onset. One other AFVI case during DEM therapy was previously described, with the presentation of only mild bleeding manifestation (subcutaneous ecchymoses) and the patient was treated with steroids 8 . In our case, the patient developed diffuse hematomas, hematuria, and consequential severe anemia, successfully treated with bypassing agents.…”

Acquired factor V inhibitor presenting as life threatening bleeding after initiation of apixaban

“…1 To date, and to our knowledge, only two cases of acquired Factor V inhibitor following the administration of oral anticoagulation have been described in the literature; one after the administration of dabigatran and the other after administration of apixaban. 2,3 We present the second reported case of acquired factor V inhibitor after administration of Apixaban.…”

Successful Management of Acquired Factor V Inhibitor by Monitoring Factor V Activity, Antigen, and Inhibitor Values during Immunosuppressive Therapy

“…The management strategy for AFVI has not yet been standardized. The distinctly different therapeutic strategies that are generally considered effective include hemostasis by transfusion with fresh frozen plasma or platelet concentrate along with the administration of recombinant activated coagulation factor VII (rFVIIa) [1, 4], and eradicating the autoantibody using immunosuppressive steroids and/or cyclophosphamide (CY), and/or immunoglobulin or plasma exchange [1, 4-6]. Global clinical guidelines are not available because AFVI is extremely rare.…”

“…However, whether FV inhibitor actually implements both of these functions in humans remains unknown. Furthermore, no correlation between degrees of bleeding and residual FV activity that is similar to a congenital FV deficiency has been reported [1, 4].…”