Déficit constitutionnel en facteur VII et chirurgie orthopédique majeure : entre risque hémorragique et risque thrombotique

The authors report the management of a 88-year-old patient with a factor VII deficiency (plasma activity level close to 5%), for total hip replacement surgery. Taken into account the absence of bleeding antecedent, and of the type of mutation (R304Q), the substitution by rFVIIa was not performed and the usual prophylaxis of postoperative venous thromboembolism with enoxaparin was applied. No excessive bleeding during surgery and no thrombosis or bleeding during the 30 postoperative days occurred. The rationale for this management is discussed.