PB0236 - Bleeding episode during a long-term anticoagulation with direct oral anticoagulant: an unusual revelation of a severe factor V deficiency

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Co-Author(s)

LG

Laurie Goubeau

Resident
Service Hematologie Biologique et UF Hemostase Clinique, Hopital Cochin AP-HP. Centre -Universite Paris Cite
Paris, Ile-de-France, France

Co-Author(s)

ZG

Zoé Guilbert

Resident
Service Hematologie Biologique et UF Hemostase Clinique, Hopital Cochin AP-HP.Centre - Universite Paris Cite
Paris, Ile-de-France, France
MS

Malika Saadi

Doctor
Service Cardiologie, Hopital Cochin, AP-HP. Centre – Universite Paris Cite
Paris, Ile-de-France, France
FP

Fabien Picard

Doctor
Service Cardiologie, Hopital Cochin, AP-HP. Centre – Universite Paris Cite
Paris, Ile-de-France, France
LP

Lucile Perrin

Doctor
Service Cardiologie, Hopital Cochin, AP-HP. Centre – Universite Paris Cite
Paris, Ile-de-France, France
LC

Ladislas Capdevila

Doctor
Service Hematologie Biologique et UF Hemostase Clinique, Hopital Cochin AP-HP.Centre - Universite Paris Cite
Paris, Ile-de-France, France
MF

Michaela Fontenay

Professor
Service Hematologie Biologique et UF Hemostase Clinique, Hopital Cochin AP-HP.Centre - Universite Paris Cite
Paris, Ile-de-France, France
JD

Jérôme Duchemin

Doctor
Service Hematologie Biologique et UF Hemostase Clinique, Hopital Cochin AP-HP.Centre - Universite Paris Cite
Paris, Ile-de-France, France
VP

Valérie Proulle

Doctor
Service Hematologie Biologique et UF Hemostase Clinique, Hopital Cochin AP-HP.Centre - Universite Paris Cite
Paris, Ile-de-France, France

Presenting Author(s)

Charlyne Brakta

Resident
Service Hématologie Biologique et Hémostase Clinique, Hôpital Cochin AP-HP.Centre - Université Paris Cité
Paris, Ile-de-France, France

Background: Direct oral anticoagulants (DOACs) are the leading treatment for stroke prevention in non-valvular atrial fibrillation (NVAF). Drug monitoring is not required as clotting tests (PT, aPTT) are uninterpretable. Misinterpretation of biological results in patients receiving DOACs and experiencing acute bleeds may result in missing underlying coagulation disorder.

Aims: To report bleeding episodes and abnormal clotting tests that led to identify an undiagnosed severe factor V (FV) deficiency in a patient receiving DOACs.

Methods: Coagulation studies were performed on a STAR-Max using Stago®/Siemens® reagents according to the manufacturer’s instructions.

Results: A 81-year-old man with multiple comorbidities and NVAF (CHA2DS2-VASc-score=4) on apixaban (5 mg bd) for 14 years presented to the emergency room after a bike fall for an extensive hematoma of the right thigh (computed tomography, CT: 3.2x8.2x11cm). Previous surgeries were uneventful. He had no familial history of coagulation disorder. Due to normal blood count, he was not admitted, local care and analgesics were prescribed. Initial abnormal clotting results were attributed to apixaban, which was not interrupted (Table 1, Day1). Three days later, he came back for acute chest pain and received 3 units of packed red blood cells and aPCC (1x100 IU/kg), despite the absence of DOACs overdose (Day3). Expanded workup was initiated to explore abnormal PT/aPTT despite withholding DOACs treatment for 3 days, leading to the diagnosis of a severe FV deficiency with no inhibitor (Day6). Due to the patient’s thromboembolic risk, FV < 3% and bleeding episode, percutaneous closure of the left auricle was proposed. The procedure was successfully performed without any hemostatic agent. Six months later, the prosthesis is in place and there is no atrial thrombus on cardiac CT.

Conclusion(s): This case underlines the importance of careful analysis of biological results to point out underlying coagulation disorder in those on DOACs therapy experiencing hemorrhage apart from an overdose.