Epidural/spinal anesthesia during delivery in women with factor XI deficiency, a single center experience.

Autor: Shacham Abulafia A; Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Yaniv Y; Helen Schneider Hospital for Women, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel., Steimatzky A; Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel., Orbach-Zinger S; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.; Department of Anesthesia, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel., Hadar E; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.; Helen Schneider Hospital for Women, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel., Shmueli A; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.; Helen Schneider Hospital for Women, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel., Borovich A; Helen Schneider Hospital for Women, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel., Ziv E; Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel., Rozovski U; Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Wiznitzer A; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.; Helen Schneider Hospital for Women, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel., Eidelman LA; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.; Department of Anesthesia, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel., Raanani P; Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel., Spectre G; Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Jazyk: angličtina
Zdroj: Haemophilia : the official journal of the World Federation of Hemophilia [Haemophilia] 2020 Sep; Vol. 26 (5), pp. 834-839. Date of Electronic Publication: 2020 Jul 14.
DOI: 10.1111/hae.14079
Abstrakt: Introduction: The safety of neuro-axial anaesthesia (epidural/spinal) at labour of women with partial factor XI (FXI) deficiency is uncertain. Although FXI deficiency is frequent in Ashkenazi Jews, it is not routinely measured before labour. Our institute serves a large Ashkenazi population. We assumed that 10% of them have undiagnosed FXI deficiency.
Aim: Assess the incidence, bleeding tendency and coagulation status among Jewish Ashkenazi women with FXI deficiency that underwent neuro-axial anaesthesia at delivery.
Methods: Jewish Ashkenazi women who underwent neuro-axial anaesthesia at labour completed the SSC ISTH bleeding assessment tool (BAT) and had blood drawn for coagulation tests, FXI and thrombin generation after labour. Estimation for 10 years was calculated from the 1-year sample.
Results: We recruited 261 women during 12 months. Among them, 39 (15%) had FXI deficiency (<70%) with median FXI levels of 63% (range: 33%-70%). Around 50% of them underwent amniocentesis in the current pregnancy and prior neuro-axial anaesthesia with no bleeding complications. BAT score and thrombin generation did not differ between women regardless of FXI status. aPTT was longer in women with partial FXI deficiency (median - 28.6 sec vs 26.3 sec, P < .001, Table 2), although within the normal range in all women. No bleeding complications after neuro-axial anaesthesia at delivery were reported in our centre in the last decade though, and according to our estimation, at least 2150 women had partial FXI deficiency.
Conclusions: A significant number of Jewish Ashkenazi women with undiagnosed partial FXI deficiency undergo neuro-axial anaesthesia at labour without bleeding complications.
(© 2020 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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