Severe hemorrhagic complication due to acquired factor V inhibitor after single exposure to bovine thrombin product

Hemorrhagic complications have been reported after repeated exposures to bo vine thrombin products due to development of factor V inhibitors. Our patie nt underwent emergency repair of acute aortic dissection and coronary arter y bypass grafting. The patient developed leg wound infection at the sapheno us vein harvest site, which was debrided and left open. Attempt to reclose the leg wound 1 month later was complicated by a life-threatening hemorrhag e with markedly elevated activated partial thromboplatin time. There was no evidence of infection or disseminated intravascular coagulation, and furth er study identified low factor V level with positive factor V inhibitor. Tr eatment with plasmapheresis and steroid successfully reversed the coagulopa thy. Detailed case review failed to reveal exposure to any thrombin product s other than the one used for the aortic dissection repair. This case was u nusual because only a single exposure to this product resulted in severe he morrhagic complication 1 month after surgery.