Background: Coagulation factors deficiency is a rare condition. Its clinical presentation is variable. It can be asymptomatic or it can cause severe hemorrhagic complications. Its association with thrombotic events is exceptional.

Aims: To put the accent on a problematic treatement in an unusual presentation of potencially bleeding factor deficiencies with thrombosis.

Methods: We report the observation of a patient with deep vein thrombosis (DVT) and acquired factor V and II deficiency.

Results: A 70-year-old diabetic and hypertensive patient was hospitalized for DVT of the left superficial femoral vein occurring in the context of prolonged bed rest.
The physical examination was normal. Biology showed a low prothrombin time (52.9%) and a prolonged activated partial thromboplastin time (M / T: 1.82) corrected by adding normal plasma.
The rate of coagulation factors showed factor II and V deficiency.
Gynecological examination, oeso-gastro-duodenal endoscopy and thoraco-abdomino-pelvic CT-Scan had not shown signs of an underlying neoplasia.
The patient was initially treated with heparin then relay with Vitamin K antagonist (VKA).
The evolution was complicated by the occurrence of a muscle hematoma related to a VKA overdose, the NIR level was at 7.14, 17 days after the treatment onset.
VKA was stopped, the patient had vitamin K, blood transfusion and prophylactic antibiotic therapy.
In this context, the decision was to definitely stop the VKA especially since the ultrasound Doppler control at 3 weeks showed total venous recanalization of
Thrombosed vein.

Conclusions: Coagulation factor deficiency can be idiopathic or secondary requiring an exhaustive etiological investigation especially solid or hematological neoplasia. It can be a threatening condition due to bleeding complications.
The peculiarity of this observation is the paradoxical and rare association of several deficiencies in coagulation factors.
Although the occurrence of thrombosis was already reported with factors deficiency, treatment however, remains challenging.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/deep-vein-thrombosis-and-coagulation-factor-deficiency-a-paradoxical-association/