We observed a successful re-challenge of warfarin therapy in a patient with atrial fibrillation and factor VII (FVII) deficiency.

Challenges with using warfarin therapy in FVII deficiency include lack of a defined optimal target international normalized ratio range and a poor correlation between the degree of FVII deficiency and bleeding risk.

We hypothesize anticoagulants which do not directly affect FVII, such as the direct oral anticoagulants, may carry less risk of bleeding complications than warfarin to reduce the risk of thromboembolic stroke in patients with atrial fibrillation and FVII deficiency.