Perioperative management for patient with congenital factor VII deficiency who underwent laparoscopic cholecystectomy: Case report

INTRODUCTION AND IMPORTANCE: In patients with congenital factor VII (FVII) deficiency, perioperative bleeding events are concern, so recombinant activated factor VII (rFVIIa) is favorably used, but the optimal dosage regimen has not clearly established. We report management of a patient with congenital FVII deficiency who underwent laparoscopic cholecystectomy. CASE PRESENTATION: A 70-year-male with congenital FVII deficiency was diagnosed as acute cholecystitis, so we planned laparoscopic cholecystectomy. FVII activity and prothrombin time international normalized ratio (PT-INR) were intraoperatively monitored as scheduled. At the start of surgery, FVII activity was 3.1% (75–130%) and PT-INR was 3.37 (0.8–1.2), so 1 mg of rFVIIa was administered. Both of these values then improved to 325.0% and 0.73, respectively. Laparoscopic cholecystectomy was successfully completed without unexpected bleeding or oozing. When FVII activity and PT-INR was re-checked 6 h after the first administration of rFVIIa, these values were 23.9% and 1.53, respectively. Additional 1 mg of rFVIIa was used only once after the operation. The patient was discharged on the sixth day after surgery without postoperative complication. CLINICAL DISCUSSION: In this case, rFVIIa was used just twice and there were no bleeding events during the perioperative period. Previous reports suggested using 15–30 μg/kg of rFVIIa before surgery and subsequent every 4–6 h in the first 24 h, then increasing the interval to 8–12 h. It is necessary to evaluate optimal dose of rFVIIa based on the risk and surgical invasiveness for each case. CONCLUSION: Our patient with congenital FVII deficiency uneventfully underwent laparoscopic cholecystectomy.