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

Abstract

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.

Obstetric and perioperative management of patients with factor XI deficiency: a retrospective observational study

“…Because no epidural/spinal hematomas were documented among 57 722 women who received neuraxial anesthesia during the span of a decade at this institute, the authors extrapolated the numbers to estimate that at least 2150 women with unknown partial FXI deficiency have safely undergone labor analgesia at their center. 10 In sum, these data challenge the practice of withholding neuraxial anesthesia solely based on low FX1 levels.…”

“…Some evidence points to plasma replacement therapy during labor not being mandatory even for women with severe FXI deficiency, as observed by Salomon et al 9 Furthermore, some anesthesiologists may be reluctant to administer neuraxial anesthesia to healthy women with FXI deficiency and no bleeding history despite growing evidence pointing toward its safety. 10 , 11 , 12 , 13 …”