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Acquired factor V inhibitor associated with valproic acid use in a cirrhotic patient
  1. B Godart1,
  2. C Boinot2,
  3. C Remblier3,
  4. A Hajjar4,
  5. M Beauchant5
  1. 1Service d’Hépato-Gastroentérologie, CHU la Milétrie, Poitiers, France
  2. 2Laboratoire d’Hématologie, CHU la Milétrie, Poitiers, France
  3. 3Service de Pharmacologie Clinique, Pavillon René le Blaye Nord, Poitiers, France
  4. 4Service de Médecine, Centre Hospitalier, Le Blanc, France
  5. 5Service d’Hépato-Gastroentérologie, CHU la Milétrie, Poitiers, France
  1. Correspondence to:
    Dr B Godart
    Service d’Hépato-Gastroentérologie, CHU La Milétrie, 86021 Poitiers cedex, France; b.godart{at}9online.fr

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Acquisition of factor V inhibitor is a rare event. The inhibitor most frequently encountered in clinical practice is directed against factor VIII. In a recent review of the literature, Streiff and Ness1 found 126 published cases of factor V inhibitor. The inhibitor emerged after major surgery, haemostatic therapy with bovine thrombin, malignancies, autoimmune disorders, blood transfusion, antibiotic therapy, or for unknown reasons. We report the emergence of factor V inhibitor in a cirrhotic patient receiving valproic acid for seizure control.

A 50 year old man treated for alcoholic cirrhosis was admitted for epistaxis. He had no history of autoimmune disorders or blood transfusion. For three years he had been taking valproic acid 1 g/day orally for seizures, and propranolol 60 mg/day. On admission, prothrombin level was 5% of control, factor V was 1%, and factor II was 49%. Two months previously prothrombin level had been 83% of control on two occasions one month apart. Physical examination showed compensated cirrhosis. Epistaxis was linked to telangiectasia and was controlled by meshing …

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  • Conflict of interest: None declared.