title: [Hereditary heterozygous factor VII deficiency in patients undergoing surgery : Clinical relevance].
abstract: BACKGROUND
  A hereditary deficiency in coagulation factor VII (FVII) may affect the international normalized ratio (INR) value. However, FVII deficiency is occasionally associated with a tendency to bleed spontaneously. We hypothesized that perioperative substitution with coagulation factor concentrates might not be indicated in most patients.
  
  
  METHODS
  In this retrospective data analysis, we included all patients with hereditary heterozygous FVII deficiency who underwent surgical procedures at the University Hospital Basel between December 2010 and November 2015. In addition, by searching the literature, we identified publications reporting patients with FVII deficiency undergoing surgical procedures without perioperative substitution.
  
  
  RESULTS
  We identified 22 patients undergoing 46 surgical procedures, resulting in a prevalence of 1:1500-2000. Coagulation factor concentrates were administered during the perioperative period in 15 procedures (33 %), whereas in the other 31 procedures (66 %), FVII deficiency was not substituted. No postoperative bleeding or thromboembolic events were reported. In addition, we found no differences in pre- and postoperative hemoglobin and coagulation parameters, with the exception of an improved postoperative INR value in the substituted group. In the literature review, we identified five publications, including 125 patients with FVII deficiency, undergoing 213 surgical procedures with no perioperative substitution.
  
  
  CONCLUSIONS
  Preoperative substitution using coagulation factor concentrates does not seem to be mandatory in patients with an FVII level ≥15 %. For decision-making on preoperative substitution, patient history of an increased tendency to bleed may be more important than the FVII level or increased INR value.
authors: Abteilung für Anästhesie, Hirslanden Klinik Birshof, Münchenstein, Basel, Schweiz.
authors: D
authors: D
authors: Woehrle
authors: Abteilung für Hämatologie, Universitätsspital Basel, Basel, Schweiz.
authors: M
authors: M
authors: Martinez
authors: Departement Anästhesie, Chirurgische Intensivbehandlung, Präklinische Notfallmedizin und Schmerztherapie, Universitätsspital Basel, Spitalstrasse 21, 4031, Basel, Schweiz. daniel.bolliger@usb.ch.
authors: D
authors: D
authors: Bolliger
mesh_terms: D000328:Adult; D000368:Aged; D005167:Factor VII / Q000627:therapeutic use; D005168:Factor VII Deficiency / Q000150:complications* / Q000453:epidemiology / Q000235:genetics; D005260:Female; D006579:Heterozygote; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000097:blood / Q000517:prevention & control; D015995:Prevalence; D012189:Retrospective Studies; D013923:Thromboembolism / Q000097:blood / Q000517:prevention & control; D014812:Vitamin K / Q000627:therapeutic use
chemical_list: D014812:Vitamin K; D005167:Factor VII
keywords: Bleeding risk; FVII deficiency; Perioperative coagulopathy; Rare bleeding disorders; Thromboembolic events