Successful coronary stenting in a patient with factor V deficiency in the absence of fresh frozen plasma transfusion

Abstract

Rationale:Drug-eluting stent (DES) implantation in a patient with factor V deficiency (F5D) is very complex. No antithrombotic therapy study has been reported for F5D patients who undergo a coronary stenting procedure.Patient concerns:A 73-year-old woman presented with chest discomfort and exertional dyspnea. Coronary stenting was performed successfully using DES stents.Diagnoses:The D-dimer, prothrombin time, and partial thromboplastin time prolongation persisted from admission until 24 hours after coronary stenting. Epistaxis and blood-tinged sputum occurred on day 3. The antiplatelet therapy measured using a Multiplate Analyzer was adequate, and other laboratory findings except factor V activity (14%) were within normal ranges; she was diagnosed with F5D based on low factor V activity.Interventions:While taking 90 mg of ticagrelor and 100 mg of aspirin daily, the patient revisited due to recurrent epistaxis, hemoptysis, and coughing on day 26. Epistaxis and hemoptysis stopped after the aspirin was discontinued. Finally, the daily maintenance dose was reduced to 90 mg of ticagrelor once.Outcomes:She led healthy life for 9 months without any recurrent symptoms and the test results also were stabilized.Lessons:We report a case of an F5D patient who underwent coronary stenting in the absence of frozen fresh plasma transfusion who received successful maintenance therapy using a single antiplatelet agent (90 mg of ticagrelor/day) with recurrent multiple mucosal bleeding events after coronary stenting.

Aortic Valve Replacement in Severe Factor V Deficiency and Inhibitor: Diagnostic and Management Challenges

“…In this F5D, bleeding does not correlate with FV inhibitor levels, nor the prolongation of PT, and PTT, factor activity, or the duration of the FV inhibitor [12]. F5D can be classified as mild when the FV activity is >5%, moderate 1% to 5%, and severe when it is <1% [2-3]. Our patient had severe F5D with no signs of bleeding.…”

“…The symptoms of F5D vary widely. They range from no major bleeding diathesis to minor mucosal and soft tissue bleeding (i.e., epistaxis and hemarthroses) to life-threatening bleeding, such as gastrointestinal bleeding and intracranial bleeding [2-7,9]. Although our patient had a history of recent dental surgery and nail extractions, without abnormal bleeding, preoperative laboratory assessment revealed a prolonged PT and a PTT, and an FV level <1%.…”