Pall T. Onundarson: Monitoring Warfarin Beyond Factor VII
Pall T. Onundarson, Professor Emeritus of Hematology at University of Iceland, shared a post on LinkedIn about recent articles:
“Stephanie Carlin, John Eikelboom and Emilie Belley Cote from McMaster University write a short commentary on a recent paper from China in the Thrombosis J (September 228 2026).
The report described the successful use of monitoring only factors II and X and ignoring FVII in a patient with congenital factor VII deficiency undergoing aortic and mitral mechanical heart valve replacement.
In this situation the PT INR was unusable due to its sensitivity to factor VII.
The case illustrates that II and X monitoring can successfully be used to monitor a VKA, even in a person with congenitally low FVII supporting our prior notion that ignoring FVII during warfarin management does not increase the risk of bleeding during careful monitoring.
Carlin et al discuss how this is relevant to the Fiix test and supports its potential usability for example in all patients with MHV and not only the rare case with preexisting low FVII.
I would add that our data suggest improved outcomes may be obtained in all patients needing VKAs.
Once the McMaster people start noticing the potential benefits of Fiix monitoring, more people may actually begin to see the light.”
Title 1: FIIX-based vitamin K antagonist monitoring: the promise of improved anticoagulation stability and clinical outcomes in mechanical heart valve patients
Authors: Stephanie Carlin, John W. Eikelboom, Emilie Belley-Cote
Read Full Article on Thrombosis Journal.
Title 2: Perioperative management in a patient with congenital factor VII deficiency following mechanical valve replacement
Authors: Xiaokang Luo, Xue Yang, Tucheng Sun, Xinjian Yan
Read Full Article on Journal Thrombosis.
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