Postoperative Bleeding due to Acquired Factor V Inhibitor Appearing after Cholecystectomy—A Case Report—

Abstract

A 76-year-old man with gallstone cholecystitis was referred to our department for surgery. He was administered edoxaban and underwent open subtotal cholecystectomy after heparin replacement. On postoperative day 7, the activated partial thromboplastin time (APTT) and prothrombin times (PT) were significantly prolonged and eventually became unmeasurable. Further examination revealed a marked decrease in coagulation factor V activity, and the cross-mixing test showed an inhibitor pattern, leading to the diagnosis of acquired factor V inhibitor. On postoperative day 16, the wound began to bleed profusely, and hemostasis was achieved by platelet concentrate transfusion and pressure application to the wound. Subsequently, prednisolone was administered for immunosuppressive therapy against inhibitor production. On postoperative day 35, factor V activity had recovered to 103%, and the patient was discharged on postoperative day 43.

Acquired factor V inhibitors are rare coagulopathies in which autoantibodies against coagulation factor V appear later in life. We report a case of wound bleeding due to postoperative inhibitor formation that was successfully treated with platelet transfusion and immunosuppressive therapy.