Difetti emostatici in un paziente in trattamento con anticoagulanti orali diretti

AUTORI

ABSTRACT

Emostatic abnormalities in a patient treated with direct oral anticoagulants

This case report concerns a 68-year-old man with atrial fibrillation who was being treated with edoxaban, a direct oral anticoagulant, to prevent stroke. In the patient’s medical history, two episodes of post-surgical hemorrhagic diathesis were not investigated. He sought First Aid for intense asthenia and dark stool discharge. He presented with severe anemia (hemoglobin 40 g/L) and extended coagulation tests (prothrombin ratio 8.56; activated partial thromboplastin ratio 3.83), antral gastritis, and a gastric ulcer. The prolongation of both coagulation tests suggested a decrease in the activity of one of the common pathway factors.
The subsequent performance of a mixing test, which helps to distinguish clotting time prolongation due to a coagulation factor deficiency rather than to an inhibitor, allowed us to understand that the patient might be suffering from a factor congenital deficiency. Measurements of coagulation factors showed a severe reduction in factor V activity (1.1%). The search for specific inhibitors directed against factor V was negative, confirming the suspicion that it was a congenital deficiency of factor V, a rare autosomal recessive disorder.
Anticoagulant therapy and gastric ulcer made it possible to diagnose a rare congenital disease in an elderly man. The anticoagulant therapy was interrupted and a surgical closure of the left atrial appendage was established.
Before starting anticoagulant therapy, according to consolidated guidelines, a blood count, full coagulation panel, renal, and liver function must be evaluated. Very likely, the patient, affected by congenital factor V deficiency, started the anticoagulant therapy without an adequate evaluation of the hemostasis status.

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