Thromboelastographic® monitoring of the efficacy of recombinant factor VIIa administration in a parturient with factor VII deficiency

OʼRourke, Nollag; Lee, Christopher; Kodali, Bhavani Shankar; Harnett, Miriam

doi:10.1007/bf03022632

Cited by 8 publications

(2 citation statements)

References 5 publications

(7 reference statements)

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“…Four studies of patients with factor VII deficiency were identified, 77,79,93,94 all of which described obstetric patients receiving neuraxial analgesia for labor and delivery. One case report 93 and two small retrospective cohort studies 79,94 described nine neuraxial procedures, not specifying between spinal and epidural anesthetics. There were no reports of spinal or epidural hematoma.…”

Section: Resultsmentioning

confidence: 99%

Evaluating hemostatic thresholds for neuraxial anesthesia in adults with hemorrhagic disorders and tendencies: A scoping review

Peterson

Tse

Martin

et al. 2021

Research and Practice in Thrombosis and Haemostasis

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Neuraxial anesthesia can be complicated by spinal or epidural hematoma and may result in permanent neurologic injury. There is a paucity of literature characterizing this serious complication in patients with congenital and acquired hemorrhagic disorders or tendencies. The objective of this scoping review was to describe the hemostatic laboratory parameters where neuraxial anesthesia has been administered with and without spinal and epidural hematoma in patients with preexisting hemorrhagic disorders and tendencies, including immune thrombocytopenia, gestational thrombocytopenia, thrombocytopenia associated with hypertensive disorders of pregnancy, platelet function disorders, von Willebrand disease, coagulation factor deficiencies, and fibrinogen disorders. A systematic search of Ovid MEDLINE, CINAHL, Embase, Scopus, and Web of Science was performed. Two authors independently reviewed all titles, abstracts, and full texts to determine study eligibility and extract data. Qualitative synthesis of 91 studies revealed significant gaps in our understanding of the risk of spinal and epidural hematoma in patients with hemorrhagic disorders and tendencies, including few studies of males and in nonobstetric settings. Most reviewed articles were small, retrospective studies at high risk for potential bias. With such low‐quality data, we were unable to provide any true estimates of the risk of spinal or epidural hematoma for these patients, nor could we attribute any specific hemostatic or laboratory values to increased risk of hematoma. There is a need both for larger and more rigorously designed and reported studies on this subject and for structured, comprehensive recommendations for safe administration and removal of neuraxial anesthesia in patients with hemorrhagic disorders and tendencies.

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Section: Resultsmentioning

confidence: 99%

Evaluating hemostatic thresholds for neuraxial anesthesia in adults with hemorrhagic disorders and tendencies: A scoping review

Peterson

Tse

Martin

et al. 2021

Research and Practice in Thrombosis and Haemostasis

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“…The primary adverse effect of using recombinant factor VII is an increased risk of thrombosis. It is suggested that thromboelastography, which measures whole-blood coagulation, can be used to monitor the efficacy of recombinant factor VII in the prevention of thrombosis [ 10 ]. Other traditional considerations include four-factor prothrombin complex concentrates, fresh frozen plasma (FFP), and/or tranexamic acid (TXA).…”

Section: Discussionmentioning

confidence: 99%

Factor VII Deficiency and Second Trimester Abortion: A Case Report

Nguyen¹,

Aqui²,

Milestone³

2023

Cureus

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The prevalence of factor VII deficiency (F7D) is 1 in 500,000. Due to its rarity, the management of bleeding disorders in pregnancy is not well established. We examine a case of an 18-year-old (gravida 1, para 0) woman at approximately 19 weeks gestation with a known history of F7D who presents after a motor vehicle accident. Fetal demise was confirmed necessitating a medical induction. She also had multiple fractures requiring surgical intervention. A multidisciplinary team consisting of orthopedic surgery, obstetrics and gynecology, and hematology/oncology was consulted for optimal timing of factor VII replacement prior to procedures. The patient underwent successful left tibial intramedullary nailing with minimal bleeding. She received factor VII and tolerated an uncomplicated vaginal delivery. Her postpartum and postoperative courses were uncomplicated, requiring one unit of packed red blood cells. The patient was discharged on postpartum day three. Management of this second-trimester abortion with a history of F7D was possible with effective communication and the organization of a multidisciplinary team to account for the risk of thrombosis versus hemorrhage and the availability of factor VII replacement therapy.

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Perioperative ROTEM® evaluation in a patient affected by severe VII factor deficiency undergoing microvascular decompression craniotomy for hemifacial spasm

Introna,

Broggi,

Ferroli

et al. 2024

J Clin Monit Comput

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The potential use of TEG/ROTEM® in evaluating the bleeding risk for rare coagulation disorders needs to be assessed, considering the common mismatch among laboratory tests and the clinical manifestations. As a result, there is currently no published data on the use of viscoelastic tests to assess coagulation in FVII deficient patients undergoing elective neurosurgery. We describe the case of a patient affected by severe FVII deficiency who underwent microvascular decompression (MVD) craniotomy for hemifacial spasm (HFS). The ROTEM® did not show a significant coagulopathy according to the normal ranges, before and after the preoperative administration of the recombinant activated FVII, but a substantial reduction in EXTEM and FIBTEM Clotting Times was noted. The values of coagulation in standard tests, on the contrary, were indicative of a coagulopathy, which was corrected by the administration of replacement therapy. Whether this difference between ROTEM® and standard tests is due to the inadequacy of thromboelastographic normal ranges in this setting, or to the absence of clinically significant coagulopathy, has yet to be clarified. Neurosurgery is a typical high bleeding risk surgery; additional data is required to clarify the potential role for thromboelastographic tests in the perioperative evaluation of the FVII deficient neurosurgical patients.

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Thromboelastographic® monitoring of the efficacy of recombinant factor VIIa administration in a parturient with factor VII deficiency

Cited by 8 publications

References 5 publications

Evaluating hemostatic thresholds for neuraxial anesthesia in adults with hemorrhagic disorders and tendencies: A scoping review

Evaluating hemostatic thresholds for neuraxial anesthesia in adults with hemorrhagic disorders and tendencies: A scoping review

Factor VII Deficiency and Second Trimester Abortion: A Case Report

Perioperative ROTEM® evaluation in a patient affected by severe VII factor deficiency undergoing microvascular decompression craniotomy for hemifacial spasm

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