Factor VII Deficiency, Masked by Warfarin Therapy, as a Cause of Bleeding After Cardiovascular Intervention

Excerpt

For patients undergoing warfarin therapy who are planned to have invasive diagnostic procedures or surgical interventions, two therapeutic strategies can be pursued according to the risk of bleeding and thrombosis: begin a bridging therapy with heparin or continue oral anticoagulant therapy by reducing its dosage [1]. Bridging therapy with heparin is indicated for patients at high risk of thromboembolic events, such as those with mitral valve prostheses, older aortic valve prostheses, atrial fibrillation with high congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke or vascular disease (CHADS₂) score, recent venous thromboembolism, or severe thrombophilia. Continuing warfarin therapy at a lower international normalized ratio (INR) value is indicated for patients with moderate thromboembolic risk [2]. We report the case of a patient in whom bridging therapy with low-molecular-weight heparin (LMWH) was complicated by hemorrhagic shock and unveiled a coagulation deficiency. …