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Optimizing Surgical Approaches for Patients with Inherited Factor VII Deficiency.

Pablo García-Jaén1, José Manuel Martín de Bustamante2, Ana Mendoza-Martínez2

  • 1Servicio de Hematología, Complejo Asistencial Universitario de Salamanca (CAUSA), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca (USAL), Spain.

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Surgical bleeding risk in Factor VII deficiency (FVIID) depends on FVII:C levels and bleeding score. Mild FVIID patients with higher bleeding scores and no prophylaxis face increased surgical bleeding risk.

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Area of Science:

  • Hematology
  • Surgical Management
  • Bleeding Disorders

Background:

  • Inherited Factor VII deficiency (FVIID) exhibits variable bleeding phenotypes.
  • Weak correlation between FVII:C levels and bleeding severity complicates management.
  • Surgical decision-making in FVIID requires clear predictors of bleeding outcomes.

Purpose of the Study:

  • To describe surgical management and bleeding outcomes in FVIID patients.
  • To identify key decision-making variables for FVIID surgical management.
  • To determine predictors of surgical bleeding in FVIID.

Main Methods:

  • Multicenter, retrospective study of 380 surgeries in 215 FVIID patients.
  • Classification of patients by FVII:C levels (mild, moderate, severe) and surgeries by bleeding risk (LR, HR).
  • Bleeding score (BS) defined by ISTH-BAT; decision-tree simulation performed.

Main Results:

  • Most patients had mild FVIID (76%); 69% of surgeries were low-risk (LR).
  • Prophylaxis (TA and/or rFVIIa) used in 43.9% of LR and 61% of HR surgeries.
  • Overall bleeding rate 3.1% (HR 6.8%, LR 1.5%), with most events in mild FVIID patients with BS≥3 without prophylaxis or treated with TA alone.

Conclusions:

  • FVII:C levels and surgery type guide prophylactic hemostatic treatment.
  • Mild FVIID patients with higher BS and no hemostatic treatment have increased bleeding risk.
  • Bleeding score and procedural risk predict surgical bleeding in FVIID.