Aortic valve replacement in an elderly patient with factor XI deficiency

Watanabe, S.; Minagawa, Tadanori; Kagatani, Tomoaki; Miura, Makoto; Tabayashi, K

doi:10.1007/s11748-013-0271-z

Cited by 4 publications

(4 citation statements)

References 9 publications

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“…Avci et al 10 used recombinant factor VIIa to control bleeding during mitral valvuloplasty in a 4.5‐year‐old patient with congenital FXI deficiency and reported no major postoperative bleeding. Watanabe et al 11 reported the use of fibrin glue and tranexamic acid infusion without FFP replacement or factor concentrate infusion to manage bleeding during aortic valve replacement, regardless of the preoperative aPTT of 106 seconds. They noted that the bleeding was controlled only after FFP replacement.…”

Section: Discussionmentioning

confidence: 99%

Perioperative anesthetic management in a patient with factor XI deficiency undergoing coronary artery bypass graft surgery

et al. 2020

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Spontaneous bleeding is rare in patients with factor XI deficiency and significant bleeding usually occurs after a trauma or a surgical procedure. It is difficult to maintain hemostatic balance in these patients. In the present case report, a 68‐year‐old male patient with no chronic disease was scheduled for elective cardiopulmonary bypass surgery. Eight units of fresh‐frozen plasma (FFP) were slowly infused and the operation was initiated with the activated partial thromboplastin time (aPTT) of 34.5, which was 108.7 in the preoperative period. Tranexamic acid bolus was administered before the skin incision and continued throughout the operation. Intraoperative aPTT was measured intermittently and a total of six units of FFP were administered. After 76 minutes of cross‐clamp time, the patient was separated from cardiopulmonary bypass without any problem. There is no consensus regarding the management of bleeding during cardiac surgery in patients with factor XI deficiency. The common approach includes normalizing the factor levels via FFP infusion or factor concentrates in the preoperative period, proceeding with surgery following the replacement, and close monitoring of perioperative factor levels and aPTT values.

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Section: Discussionmentioning

confidence: 99%

Perioperative anesthetic management in a patient with factor XI deficiency undergoing coronary artery bypass graft surgery

et al. 2020

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“…In the USA and Japan, the only replacement therapy is FFP. 6 There have been no reports of FXI concentrate used for treatment of FXI deficiency in a patient undergoing AVR. We used Hemoleven as the replacement therapy of choice because it prevents massive bleeding perioperatively.…”

Section: Discussionmentioning

confidence: 99%

“…8 Of the 10% of patients treated with FXI concentrate who developed arterial thrombosis or venous thromboembolism, almost all were predisposed to thrombosis, elderly, and had cardiovascular disease. 6 Routinely, our patient received acenocoumarol and enoxaparin.…”

Section: Discussionmentioning

confidence: 99%

Factor XI deficiency and aortic valve replacement: Perioperative management

Petroulaki

Lazopoulos

Chaniotaki

et al. 2016

Asian Cardiovasc Thorac Ann

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Severe factor XI deficiency (hemophilia C) is a rare coagulation disorder. A 73-year-old woman, a homozygote for factor XI deficiency, required aortic valve replacement. An initial dose of 15 U kg of factor XI concentrate was administered preoperatively and on postoperative day 3. During surgery, concentrated red cells, fresh frozen plasma, platelets, tranexamic acid, and fibrinogen were transfused. Intraoperative bleeding and total chest drainage were minimal. Postoperatively, there was no need for further transfusions and no bleeding or thrombotic complications occurred. The patient was well 16 months after surgery.

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“…7 Two case reports described the management of FXI deficiency in the setting of aortic valve replacement. 8,9 One patient was managed successfully with FFP and tranexamic acid and the other with FXI concentrates without excessive bleeding. A paediatric case described a 4.5-year-old male with FXI deficiency underwent a mitral valvuloplasty that was supported with nine serial doses of rFVIIa at 90 mcg/kg IV without excessive perioperative bleeding 13 .…”

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confidence: 99%