Internal and Emergency Medicine

, Volume 14, Issue 8, pp 1353–1356 | Cite as

Direct oral anticoagulants in factor VII deficiency patient

  • Fulvio PomeroEmail author
  • Laura Spadafora
  • Salvatore D’Agnano
  • Francesco Dentali
  • Luigi Maria Fenoglio
CE - Research Letter to the Editor

Dear Sir,

Factor VII (FVII) is a vitamin K-dependent coagulation factor synthesized in the liver which plays a major role in the coagulation extrinsic pathway which is initiated at tissue damage sites, following the formation of a complex between activated FVII (FVIIa) and tissue factor. Plasma levels range around 0.35–0.60 mg/L (for a normal coagulant activity comprised between 70 and 140%), which is 10 times less than other vitamin K-dependent factors. Its half-life is extremely short (4–6 h) [ 1]. Inherited FVII deficiency, with an estimated prevalence of 1:300,000 population in European countries, is the most common among the rare congenital coagulation disorders, characterized by autosomal recessive inheritance. As with other forms of hemophilia, FVII deficiency can also be caused by medications such as vitamin K antagonists (VKA), medical conditions or malabsorption [ 2, 3]. Suspicion of FVII deficiency arises in presence of a reduced FVII coagulant activity (FVII:C), a prolonged...



The authors received no financial support for the research, authorship, and/or publication of this article.

Compliance with ethical standards

Conflict of interests

The authors state that they have no conflict of interest.

Statement of human and animal rights

This article does not contain any studies with animals performed by any of the authors. All procedures performed were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. As the case report is retrospective, discussion in the Ethics Committee was waived.

Informed consent

Informed consent was obtained from the patient included in the study.


  1. 1.
    Lapecorella M, Mariani G (2008) Factor VII deficiency: defining the clinical picture and optimizing therapeutic options. Haemophilia 14:1170–1175CrossRefGoogle Scholar
  2. 2.
    Perry DJ (2002) Factor VII deficiency. Br J Haematol 118:689–700CrossRefGoogle Scholar
  3. 3.
    Tana M, Tana C, Amerio P, Vitullo G, Di Giosia P, Di Febbo C, Davì G (2015) Severe non-traumatic bleeding, the answer is not in the blood. Intern Emerg Med 10(4):461–464CrossRefGoogle Scholar
  4. 4.
    Giansily-Blaizot M, Verdier R, Biron-Andréani C (2004) Study group of FVII deficiency. Analysis of biological phenotypes from 42 patients with inherited factor VII deficiency: can biological tests predict the bleeding risk? Haematologica 89:704–709PubMedGoogle Scholar
  5. 5.
    Girolami A, Berti de Marinis G, Bertozzi I, Peroni E, Tasinato V, Lombardi AM (2013) Discrepant ratios of arterial vs. venous thrombosis in hemophilias A and B as compared to FVII deficiency. Eur J Haematol 91:152–156CrossRefGoogle Scholar
  6. 6.
    Peyvandi F, di Michele D, Bolton-Maggs PH et al (2012) Classification of rare bleeding disorders (RBDs) based on the association between coagulant factor activity and clinical bleeding severity. J Thromb Haemost 10(9):1938–1943CrossRefGoogle Scholar
  7. 7.
    Davidson SJ, Turner N, Tillyer L (2010) Anticoagulation of a patient with hypertrophic cardiomyopathy and factor VII deficiency. Blood Coagul Fibrinolysis 21:707–708CrossRefGoogle Scholar
  8. 8.
    Baltodano LE, Mungall DR, Watson DD (1998) Management of a patient with atrial fibrillation and factor VII deficiency. Ann Pharmacother 32:1251–1252CrossRefGoogle Scholar
  9. 9.
    Arellano-Rodrigo E, Gironella M, Nicolau I, Vila M (2009) Clinical management of thrombosis in inherited factor VII deficiency: a description of two cases. Thromb Haemost 101:402–404CrossRefGoogle Scholar
  10. 10.
    Paulus E, Komperda K, Park G, Fusco J (2016) Anticoagulation therapy considerations in factor VII deficiency. Drug Saf -Case Rep 3:8CrossRefGoogle Scholar
  11. 11.
    Arletti L, Coluccio V, Romagnoli E, Luppi M, Marietta M (2019) Direct oral anticoagulants for atrial fibrillation in patients with congenital factor VII deficiency. Eur J Haematol 103:67–69CrossRefGoogle Scholar
  12. 12.
    Prisco D, Ageno W, Becattini C, D'Angelo A, Davì G, De Cristofaro R, Dentali F, Di Minno G, Falanga A, Gussoni G, Masotti L, Palareti G, Pignatelli P, Santi RM, Santilli F, Silingardi M, Tufano A, Violi F (2017) Italian intersociety consensus on DOAC use in internal medicine. Intern Emerg Med 12(3):387–406CrossRefGoogle Scholar
  13. 13.
    Prisco D (2018) A focus on direct oral anticoagulants: "old" and possible new indications and efforts for a better clinical management. Intern Emerg Med 13(7):985–988CrossRefGoogle Scholar
  14. 14.
    Marongiu F, Barcellona D (2018) Direct oral anticoagulants: what can we learn? Intern Emerg Med 13(7):989–992CrossRefGoogle Scholar
  15. 15.
    Paul B, Oxeley A, Brigham K, Cox T, Hamilton PJ (1987) Factor II, VII, IX, and X concentrations in patients receiving long term warfarin. J Clin Pathol 40:94–98CrossRefGoogle Scholar

Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  1. 1.U.O. Medicina InternaOspedale S. LazzaroAlbaItaly
  2. 2.Emergency DepartmentS. Paolo HospitalSavonaItaly
  3. 3.Specialty Training in Internal MedicineUniversity of TurinTurinItaly
  4. 4.Department of Clinical MedicineUniversity of InsubriaVareseItaly
  5. 5.Department of Internal MedicineASO S. Croce E CarleCuneoItaly

Personalised recommendations