Management of a patient with a mechanical aortic valve and antibodies to both thrombin and factor V after repeat exposure to fibrin sealant

We describe a patient who developed a markedly prolonged PT, PTT, and throm bin time 13 days after repeat exposure to fibrin sealant during coronary ar tery bypass grafting and aortic valve replacement. Evaluation revealed an i nhibitor to bovine thrombin that crossreacted with human thrombin, In addit ion an inhibitor to human coagulation factor V was identified, Despite coag ulation abnormalities there was no evidence of bleeding. Nevertheless, effe ctive anticoagulation was required to minimize the thrombotic complications associated with the patient's prosthetic valve, We elected to take a conse rvative approach and not utilize pharmacologic anticoagulation until there was diminution in the effect of the acquired inhibitors, We report on our p atient's course and review the available literature addressing the manageme nt of patients demonstrating inhibitors to blood coagulation factors after repeat exposure to fibrin sealants. Am. J. Hematol. 64:59-63, 2000, (C) 200 0 Wiley-Liss, Inc.