ArticleSurgical case reports2023
Fatal acquired coagulation factor V deficiency after hepatectomy for advanced hepatocellular carcinoma as a possible immune checkpoint inhibitor-related adverse event: a case report.
Article in Surgical case reports, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 6 citations in OpenAlex.
- Acquired Autoimmune Factor XIII Deficiency as a Novel Immune-Related Adverse Event of Combined Ipilimumab and Nivolumab Therapy for Renal Cell Carcinoma: A Case Report.IJU case reports · 2026Article
- Perioperative Blood Management on a Successful Surgical Operation of a Patient With Congenital Coagulation Factor V Deficiency.Clinical case reports · 2025Article
- Hepatoblastoma: From Molecular Mechanisms to Therapeutic Strategies.Current oncology (Toronto, Ont.) · 2025Review
- Successful Hemostasis With Platelet Transfusion and Tranexamic Acid, and Inhibitor Elimination With Cyclosporine, in Steroid-Resistant Acquired Coagulation Factor V Deficiency Caused by Antibiotic Readministration.Case reports in hematology · 2025Article
- Retrospectively diagnosed autoimmune VWF deficiency in a patient with repeated hemorrhagic events after two common colds.International journal of hematology · 2024Article
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Authors and funding
14 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundAtezolizumab plus bevacizumab therapy was recently introduced as the first line for unresectable advanced hepatocellular carcinoma (HCC), but immune-related adverse events (IrAEs) due to atezolizumab are a great concern. Here, we report the case of a patient who developed fatal acquired coagulation factor deficiency after hepatectomy for HCC, treated with atezolizumab and bevacizumab before surgery. CASE PRESENTATION: A 70-year-old man received right trisegmentectomy of the liver with hepaticojejunostomy for advanced HCC with bile duct invasion, after atezolizumab and bevacizumab therapy. The patient suffered the sudden onset of severe multiple coagulation factor deficiency (II, V, VII, VIII, IX, X, XI and XII) immediately following reoperation for anastomotic leakage of hepaticojejunostomy, 7 days after hepatectomy. The coagulation factor deficiency did not reverse even with intensive treatment, and the patient died of uncontrollable bleeding 32 days after hepatectomy. An IrAE due to atezolizumab was suspected because the patient had developed the possible IrAE of enthesitis of the right gastrocnemius muscle before surgery, and specific inhibitors against factor V and anti-factor V autoantibodies were detected, leading to an ultimate diagnosis of autoimmune FV/5 deficiency (AiF5D).
conclusionSevere acquired coagulopathy should be recognized as a possible life-threatening IrAE when using atezolizumab and bevacizumab for HCC.
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