Managing the Complexity of Thrombotic and Bleeding Risks: Case Report of Factor VII Deficiency and Factor V Leiden Mutation in a Patient With Bi-valvular Infective Endocarditis Undergoing Open-heart Surgery.

Factor VII deficiency (FVIID) is a rare autosomal dominant disorder that occurs in approximately 1 in 500,000 individuals. Paradoxically, 3-4 percent of cases of FVIID result in thrombosis. The etiology behind this clotting predilection is thought to be multifactorial, possibly due to an associated pro-coagulant mutation. We hereby describe a case of FVIID with a heterozygous Factor V Leiden mutation (FVLM) in a patient with bivalvular infective endocarditis undergoing open-heart surgery. This case highlights the complexity of managing patients with concomitant bleeding and thrombotic tendencies, especially in the context of major surgery. We recommend tailoring anticoagulation strategies on a case by case basis to manage these risks.