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Barg AA, Livnat T, Kenet G. Factor XI deficiency: phenotypic age-related considerations and clinical approach towards bleeding risk assessment. Blood 2024; 143:1455-1464. [PMID: 38194679 DOI: 10.1182/blood.2023020721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/22/2023] [Accepted: 12/29/2023] [Indexed: 01/11/2024] Open
Abstract
ABSTRACT Factor XI (FXI) deficiency is a rare bleeding disorder that presents complex challenges in patient assessment and bleeding risk management. Despite generally causing mild to moderate bleeding symptoms, clinical manifestations can vary, and bleeding tendency does not always correlate with FXI plasma levels or genotype. Our manuscript delves into the age-related nuances of FXI deficiency across an individual's lifespan. We emphasize issues faced by specific groups, including neonates and females of reproductive age experiencing abnormal uterine bleeding and postpartum hemorrhage. Older patients present unique challenges and concerns related to the management of bleeding as well as thrombotic complications. The current assortment of diagnostic laboratory assays shows limited success in predicting bleeding risk in the perisurgical setting of patients with FXI deficiency. This review explores the intricate interplay between individual bleeding profiles, surgical sites, and FXI activity levels. We also evaluate the accuracy of existing laboratory assays in predicting bleeding and discuss the potential role of investigational global assays in perioperative assessment. Furthermore, we outline our suggested diagnostic approach to refine treatment strategies and decision making. Available treatment options are presented, including antifibrinolytics, replacement products, and recombinant activated FVII. Finally, we discuss promising nonreplacement therapies for the treatment of rare bleeding disorders that can potentially address the challenges faced when managing FXI deficiency-related bleeding complications.
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Affiliation(s)
- Assaf Arie Barg
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institution of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel; and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tami Livnat
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institution of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel; and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gili Kenet
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institution of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel; and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kasonga F, Feugray G, Chamouni P, Barbay V, Fresel M, Chretien MH, Brunel S, Le Cam Duchez V, Billoir P. Evaluation of thrombin generation assay in factor XI deficiency. Clin Chim Acta 2021; 523:348-354. [PMID: 34670127 DOI: 10.1016/j.cca.2021.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Factor XI (FXI) deficiency is characterized by a lack of correlation between FXI plasma levels and the occurrence of hemorrhagic events. The main objective of our study was to determine whether thrombin generation assay (TGA) could be used to assess the hemorrhagic phenotype of patients with FXI deficiency. MATERIAL AND METHODS All patients had confirmed laboratory measurement of FXI < 50% in two plasma samples. Relevant bleeding history was evaluated by a senior physician. TGA was performed with Calibrated Automated Thrombography, in platelet poor plasma, from patients and healthy controls. The assay was performed with PPP low reagent (1 pM of human tissue factor). RESULTS Seventy-six patients with FXI deficiency were included between 2011 and 2020. Among them, eight patients had severe deficiency (FXI < 15%). Mean age was 34 years [range: 9-77]. Endogenous thrombin potential (ETP) was significantly lower in patients with FXI deficiency and bleeding (573 nM·min [225-1214]) or no bleeding (732 nM·min [222-1435]), compared to healthy controls (1184 nM·min [933-1518]). No difference was observed for ETP and peak between patients with FXI deficiency and bleeding and patients with FXI deficiency and no bleeding. No difference was observed for ETP (923 nM·min [377-1497] vs 1063 nM·min [252-2529]), peak (82 nM [28-154] vs 131 nM [20-330]) or velocity (13.7 nM/min [3.6-29.6] vs 26.5 nM/min [2.5-90]) in women with (n = 4) and without history (n = 17) of post-partum bleeding. No difference of thrombin generation was observed in pregnant women with FXI deficiency (ETP: 1395 nM·min [351-2529]; peak: 154 nM [26-330]; velocity: 29.6 nM/min [4.1-90.0]), compared to healthy controls and a control group of healthy pregnant women. CONCLUSION In conclusion, under our experimental condition, a non-significant decrease of thrombin generation was observed in plasma samples of patients with FXI deficiency and bleeding. Our results suggest an increase of coagulation parameters during pregnancy in women with FXI deficiency. A larger sample size or other experimental conditions are required to evaluate the use of TGA in FXI deficiency.
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Affiliation(s)
- Fiston Kasonga
- CHU Rouen, Vascular Hemostasis Unit, F-76000 Rouen, France
| | - Guillaume Feugray
- Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, F-76000 Rouen, France
| | | | - Virginie Barbay
- CHU Rouen, Vascular Hemostasis Unit, F-76000 Rouen, France; CHU Rouen, Hemophilia Care Center, F 76000 Rouen, France
| | | | | | - Sabine Brunel
- CHU Rouen, Vascular Hemostasis Unit, F-76000 Rouen, France
| | - Véronique Le Cam Duchez
- Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, F-76000 Rouen, France
| | - Paul Billoir
- Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, F-76000 Rouen, France.
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The association between coagulopathies such as thrombophilia or rare bleeding disorders with the development of gestational vascular complications. Blood Coagul Fibrinolysis 2021; 31:S25-S27. [PMID: 33351500 DOI: 10.1097/mbc.0000000000000987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The association between coagulopathies, more specifically thrombophilia, and the development of gestational vascular complications was established in the 1990s. Ever since, huge efforts have been invested into gaining a better understanding of the role played by clotting factors, both prothrombotic and hemorrhagic, in those complications, not least because hypertensive disorders and venous thromboembolism are among the most common causes of maternal mortality in the Western world.
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Murray NP, Ilabaca J, Guzman E, Orrega S. Management of mild congenital deficiency of Factor XI with a Factor XI inhibitor in pregnancy: A clinical case. Hematol Transfus Cell Ther 2021; 44:444-446. [PMID: 33622647 PMCID: PMC9477763 DOI: 10.1016/j.htct.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/30/2020] [Accepted: 01/07/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Nigel P Murray
- Hospital de Carabineros de Chile, Santiago, Chile; Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile.
| | - Javier Ilabaca
- Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Eghon Guzman
- Hospital de Carabineros de Chile, Santiago, Chile
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Acquired Factor XI Deficiency with Lupus Anticoagulant in a Pregnant Woman Diagnosed by the Eruptions and Pain in Fingers. Case Rep Obstet Gynecol 2020; 2020:8854676. [PMID: 33489393 PMCID: PMC7803157 DOI: 10.1155/2020/8854676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 12/17/2022] Open
Abstract
We report a case of acquired factor XI deficiency with lupus anticoagulant (LA) in a 28-year-old primigravida who presented with finger pain and eruptions on her palms and fingers during the 3rd trimester of pregnancy. The patient complained of pain and reddening of the fingers at 30 weeks of gestation. She was referred to our tertiary center with a diagnosis of preeclampsia and suspected collagen disease at 35 weeks of gestation. Erythema was seen on the fingers and palms, and she presented with pain and cryesthesia on the fingers. Laboratory investigations revealed an activated partial thromboplastin time of 51 s (normal, 23–40 s), although it was normal during the 30th and 34th gestational weeks, LA with an anticardiolipin-beta2-glycoprotein I complex antibody, and low level of clotting XI activity (25 U/mL). On week 37 day 0 of gestation, the patient presented with severe hypertension. An urgent Cesarean section was performed after transfusion of two units of fresh frozen plasma. There was no excessive bleeding during the surgery or the postpartum period. The symptoms on her fingers and palms gradually improved after surgery. Our case indicates that dermatoses of pregnancy may become a starting point for the diagnosis of autoimmune diseases and coagulation abnormalities. When a patient presents with an atypical symptom, as in our case, the possibility of various diseases should be considered.
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Postpartum bleeding in women with inherited bleeding disorders: a matched cohort study. Blood Coagul Fibrinolysis 2020; 31:452-458. [DOI: 10.1097/mbc.0000000000000945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stoeckle JH, Bogue T, Zwicker JI. Postpartum haemorrhage in women with mild factor XI deficiency. Haemophilia 2020; 26:663-666. [PMID: 32558038 DOI: 10.1111/hae.14081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION With the advent of direct-to-consumer genetic testing, mild factor XI deficiency is increasingly recognized. There are limited data regarding the risk of postpartum haemorrhage (PPH) among women with mild FXI deficiency following obstetrical delivery. AIM To assess the risk of PPH among women with mild FXI deficiency undergoing vaginal or caesarean delivery. METHODS We conducted a retrospective, case-control study, in women with FXI levels between 20% and 70% of normal. For a control population, delivery outcomes were analysed in 200 women (between 2016 and 2018) without known bleeding disorders. RESULTS There was no PPH among 45 vaginal deliveries in women with mild FXI deficiency compared with one PPH among 125 vaginal deliveries in the control cohort. The rate of PPH was significantly higher among the 26 caesarean deliveries in women with mild FXI deficiency relative to 75 control caesarean deliveries (odds ratio 2.73, 95% CI 1.02-7.26, P = .04). Prior history of haemorrhage was a strong predictor of PPH following caesarean delivery. All women who developed PPH following caesarean delivery had either a history of haemorrhage or independent risk factor for PPH. CONCLUSION Due to the low rates of postpartum haemorrhage following vaginal delivery, routine prophylaxis to prevent postpartum haemorrhage in the setting of mild FXI deficiency does not appear warranted, especially in the absence of a bleeding history. Mild FXI deficiency is associated with an increased risk of PPH following caesarean delivery.
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Affiliation(s)
- James H Stoeckle
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas Bogue
- Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey I Zwicker
- Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Wheeler AP, Hemingway C, Gailani D. The clinical management of factor XI deficiency in pregnant women. Expert Rev Hematol 2020; 13:719-729. [PMID: 32437625 DOI: 10.1080/17474086.2020.1772745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Factor XI (FXI) deficiency is associated with highly variable bleeding, including excessive gynecologic and obstetrical bleeding. Since approximately 20% of FXI-deficient women will experience pregnancy-related bleeding, careful planning and knowledge of appropriate hemostatic management is pivotal for their care. AREAS COVERED In this manuscript, authors present our current understanding of the role of FXI in hemostasis, the nature of the bleeding phenotype caused by its deficiency, and the impact of deficiency on obstetrical care. The authors searched PubMed with the terms, 'factor XI', 'factor XI deficiency', 'women', 'pregnancy', and 'obstetrics' to identify literature on these topics. Expectations of pregnancy-related complications in women with FXI deficiency, including antepartum, abortion-related, and postpartum bleeding, as well as bleeding associated with regional anesthesia are discussed. Recommendations for the care of these women are considered, including guidance for management of prophylactic care and acute bleeding. EXPERT COMMENTARY FXI deficiency results in a bleeding diathesis in some, but not all, patients, making treatment decisions and clinical management challenging. Currently available laboratory assays are not particularly useful for distinguishing patients with FXI deficiency who are prone to bleeding from those who are not. There is a need for alternative testing strategies to address this limitation.
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Affiliation(s)
- Allison P Wheeler
- Department of Pathology, Microbiology and Immunology, Vanderbilt University , Nashville, TN, USA.,Department of Pediatrics, Vanderbilt University , Nashville, TN, USA
| | - Celeste Hemingway
- Department of Obstetrics and Gynecology, Vanderbilt University , Nashville, TN, USA
| | - David Gailani
- Department of Pathology, Microbiology and Immunology, Vanderbilt University , Nashville, TN, USA
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Gerber GF, Klute KA, Chapin J, Bussel J, DeSancho MT. Peri- and Postpartum Management of Patients With Factor XI Deficiency. Clin Appl Thromb Hemost 2020; 25:1076029619880262. [PMID: 31595781 PMCID: PMC6900674 DOI: 10.1177/1076029619880262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Factor XI (FXI) deficiency is an uncommon autosomal disorder with variable bleeding phenotype, making peripartum management challenging. We describe our experience in pregnant women with FXI deficiency and identify strategies to minimize the use of hemostatic agents and increase utilization of neuraxial anesthesia. Electronic records of 28 pregnant women with FXI deficiency seen by a hematology service in an academic medical center from January 2006 to August 2018 were reviewed. Data on bleeding, obstetric history, peripartum management, and FXI activity were collected. Partial FXI deficiency was defined as >20 IU/dL and severe <20 IU/dL. Median FXI activity was 42 IU/dL (range <1-73 IU/dL), and median activated partial thromboplastin time was 32.2 seconds (range: 27.8-75 seconds). There were 64 pregnancies: 53 (83%) live births and 11 (17%) pregnancy losses. Postpartum hemorrhage occurred in 9 (17%) pregnancies. Antifibrinolytic agents and fresh frozen plasma were used only in women with severe deficiency (42% with bleeding and 17% with no bleeding phenotype, respectively). Neuraxial anesthesia was successfully administered in 32 (59%) deliveries. Most women with FXI deficiency have uncomplicated pregnancies and deliveries with minimal hemostatic support. Neuraxial anesthesia can be safely administered in most women.
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Affiliation(s)
- Gloria F Gerber
- Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, NY, USA
| | - Kelsey A Klute
- Division of Oncology and Hematology, University of Nebraska Medical Center, Omaha, NE, USA
| | - John Chapin
- Clinical Development, CRISPR Therapeutics, Cambridge, MA, USA
| | - James Bussel
- Division of Hematology-Oncology, Department of Pediatrics, Weill Cornell Medicine, New York Presbyterian Hospital, NY, USA
| | - Maria T DeSancho
- Division of Hematology-Oncology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, NY, USA
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Bannow BS, Konkle BA. Inherited Bleeding Disorders in the Obstetric Patient. Transfus Med Rev 2018; 32:237-243. [DOI: 10.1016/j.tmrv.2018.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/13/2018] [Indexed: 02/06/2023]
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Wool GD, Treml A, Miller JL. Acquired factor XI deficiency and therapeutic plasma exchange. J Clin Apher 2017; 33:427-430. [PMID: 29027258 DOI: 10.1002/jca.21593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/25/2017] [Accepted: 10/01/2017] [Indexed: 12/19/2022]
Abstract
Congenital factor XI (FXI) deficiency is associated with a variable bleeding phenotype. Recent reports have documented the use of therapeutic plasma exchange to rapidly and isovolumetrically increase FXI levels before invasive procedures in patients with congenital FXI deficiency. We report a case of acquired FXI deficiency in a pregnant woman with lupus. We proved that the inhibitor was an IgG, therefore potentially capable of crossing the placenta. While immune suppression eliminated detectable circulating inhibitor, the woman's FXI remained quite low. A multi-disciplinary team was formed and therapeutic plasma exchange with 100% plasma replacement was performed when the patient went into labor, to acutely raise her FXI level and remove any potential non-neutralizing inhibitor. The mother had a controllable level of bleeding during post-TPE cesarean section; the baby had no bleeding and the baby's FXI levels were not overtly abnormal. Therapeutic plasma exchange in acquired FXI deficiency (or other acquired hemophilias) can both acutely isovolumetrically raise factor levels and remove any circulating inhibitor.
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Affiliation(s)
- Geoffrey D Wool
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Angela Treml
- Department of Pathology, University of Chicago, Chicago, Illinois
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12
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Verghese L, Tingi E, Thachil J, Hay C, Byrd L. Management of parturients with Factor XI deficiency—10 year case series and review of literature. Eur J Obstet Gynecol Reprod Biol 2017. [DOI: 10.1016/j.ejogrb.2017.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wiewel-Verschueren S, Arendz IJ, M. Knol H, Meijer K. Gynaecological and obstetrical bleeding in women with factor XI deficiency - a systematic review. Haemophilia 2015; 22:188-195. [DOI: 10.1111/hae.12856] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 12/15/2022]
Affiliation(s)
- S. Wiewel-Verschueren
- Division of Haemostasis and Thrombosis; Department of Haematology; University of Groningen University Medical Centre Groningen; Groningen The Netherlands
- Department of Obstetrics and Gynaecology; University of Groningen University Medical Centre Groningen; Groningen The Netherlands
| | - I. J. Arendz
- Department of Obstetrics and Gynaecology; University of Groningen University Medical Centre Groningen; Groningen The Netherlands
| | - H. M. Knol
- Department of Obstetrics and Gynaecology; University of Groningen University Medical Centre Groningen; Groningen The Netherlands
- Isala Clinics Department of Obstetrics and Gynaecology; Zwolle The Netherlands
| | - K. Meijer
- Division of Haemostasis and Thrombosis; Department of Haematology; University of Groningen University Medical Centre Groningen; Groningen The Netherlands
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Davies J, Harper A, Kadir RA. The role of rotational thromboelastometry in assessment of haemostasis during pregnancy in women with factor XI deficiency. Haemophilia 2015; 22:276-284. [DOI: 10.1111/hae.12807] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/13/2015] [Accepted: 08/15/2015] [Indexed: 12/01/2022]
Affiliation(s)
- J. Davies
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit; Department of Obstetrics and Gynaecology; Royal Free Hospital NHS Foundation Trust; Hampstead London UK
| | - A. Harper
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit; Department of Obstetrics and Gynaecology; Royal Free Hospital NHS Foundation Trust; Hampstead London UK
| | - R. A. Kadir
- Katharine Dormandy Haemophilia Centre and Thrombosis Unit; Department of Obstetrics and Gynaecology; Royal Free Hospital NHS Foundation Trust; Hampstead London UK
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Wintenberger C, Boccon-Gibod I, Launay D, Fain O, Kanny G, Jeandel PY, Martin L, Gompel A, Bouillet L. Tranexamic acid as maintenance treatment for non-histaminergic angioedema: analysis of efficacy and safety in 37 patients. Clin Exp Immunol 2014; 178:112-7. [PMID: 24827773 DOI: 10.1111/cei.12379] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2014] [Indexed: 02/06/2023] Open
Abstract
Angioedema (AE) is a clinical syndrome characterized by localised swelling lasting several hours. The swelling is often recurring and can be lethal if it is located in the laryngeal region. Much progress has been made recently in the treatment of acute episodes, but no consensus has been reached on maintenance treatment. We have performed a national retrospective observational study to assess the use of tranexamic acid (TA) as maintenance treatment for non-histaminergic AE [hereditary AE (HAE) or idiopathic non-histaminergic AE]. Records for 64 cases were collected from 1 October 2012 to 31 August 2013; 37 of these were included (12 HAE with C1-inhibitor deficiency, six with HAE with normal C1-inhibitor and 19 idiopathic non-histaminergic AE). When treated with TA over six months, the number of attacks was reduced by 75% in 17 patients, 10 patients showed a lower level of reduction and 10 had the same number of attacks. In no instances were symptoms increased. No thromboembolic events were observed, and the main side effects were digestive in nature. Thus, TA, which is well tolerated and inexpensive, appears to be an effective maintenance treatment for some patients with HAE or idiopathic non-histaminergic AE.
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Affiliation(s)
- C Wintenberger
- Department of Internal Medicine, University Hospital, Grenoble, France
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Akladios C, Sananes N, Gaudineau A, Boudier E, Langer B. Hémorragie secondaire du post-partum. ACTA ACUST UNITED AC 2014; 43:1161-9. [DOI: 10.1016/j.jgyn.2014.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Caballero T, Canabal J, Rivero-Paparoni D, Cabañas R. Management of hereditary angioedema in pregnant women: a review. Int J Womens Health 2014; 6:839-48. [PMID: 25228822 PMCID: PMC4164109 DOI: 10.2147/ijwh.s46460] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
THREE TYPES OF HEREDITARY ANGIOEDEMA (HAE) HAVE BEEN DESCRIBED two are due to C1 inhibitor (C1-INH) deficiency (C1-INH-HAE types I and II) and one is characterized by normal C1-INH (nC1-INH-HAE). The management of pregnancy in patients with HAE is often a clinical challenge owing to potential worsening of the disease in relation to the physiological increase in estrogens and the limited treatment options. This review addresses the potential influence of pregnancy on the clinical severity of hereditary angioedema and the management of this disease during pregnancy with currently available treatments.
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Affiliation(s)
- Teresa Caballero
- Hospital La Paz Institute for Health Research, (IdiPaz), Madrid, Spain
- Biomedical Research Network on Rare Diseases-U754 (CIBERER), Madrid, Spain
| | - Julio Canabal
- Hospital La Paz Institute for Health Research, (IdiPaz), Madrid, Spain
| | | | - Rosario Cabañas
- Hospital La Paz Institute for Health Research, (IdiPaz), Madrid, Spain
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Reuveni A, Orbach-Zinger S, Eidelman LA, Ginosar Y, Ioscovich A. Peripartum anesthetic management of patients with Factor XI deficiency. J Perinat Med 2014; 42:295-300. [PMID: 24096436 DOI: 10.1515/jpm-2013-0144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 09/08/2013] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Factor XI deficiency is predominantly found in the Ashkenazi Jewish population with a prevalence of 9%, but also seen in other ethnicities. Little information is available on obstetric anesthesia management in women with Factor XI deficiency. Therefore, we undertook a study to evaluate obstetric, anesthetic and perinatal outcomes in parturients with Factor XI deficiency. METHODS A retrospective study was conducted with chart reviews from 1996 to 2011 resulted in 74 women with Factor XI level deficiency. We compared anesthetic and obstetric management in parturients with low (≤30%) level of Factor XI to those with higher levels. RESULTS Ninety-one pregnancy outcomes were reviewed in these 74 women with Factor XI deficiency. Forty-three women had levels ≤30% in 46 labors while 31 women had levels >30% in 45 labors. Women with low levels of Factor XI were significantly more likely to receive FFP and less likely to receive neuroaxial anesthesia. There were no anesthetic complications and no difference in mode of delivery or neonatal outcomes. DISCUSSION This study is the first step in building a national database for anesthetic cases and outcomes of parturients with Factor XI deficiency. Further efforts must be made to provide safe analgesia for these women.
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Caballero T, Farkas H, Bouillet L, Bowen T, Gompel A, Fagerberg C, Bjökander J, Bork K, Bygum A, Cicardi M, de Carolis C, Frank M, Gooi JH, Longhurst H, Martínez-Saguer I, Nielsen EW, Obtulowitz K, Perricone R, Prior N. International consensus and practical guidelines on the gynecologic and obstetric management of female patients with hereditary angioedema caused by C1 inhibitor deficiency. J Allergy Clin Immunol 2012; 129:308-20. [DOI: 10.1016/j.jaci.2011.11.025] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 10/27/2011] [Accepted: 11/21/2011] [Indexed: 10/14/2022]
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Guéguen P, Galinat H, Blouch MT, Bridey F, Duchemin J, Le Gal G, Abgrall JF, Pan-Petesch B. Biological determinants of bleeding in patients with heterozygous factor XI deficiency. Br J Haematol 2011; 156:245-51. [DOI: 10.1111/j.1365-2141.2011.08945.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Babarinsa IA, Hayman RG, Draycott TJ. Secondary post-partum haemorrhage: challenges in evidence-based causes and management. Eur J Obstet Gynecol Reprod Biol 2011; 159:255-60. [PMID: 21839573 DOI: 10.1016/j.ejogrb.2011.07.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 07/07/2011] [Accepted: 07/14/2011] [Indexed: 11/29/2022]
Abstract
Secondary postpartum haemorrhage (SPPH) is an important post-natal issue, whose significance is perceived differently between practices, settings and probably within cultures. It is generally less focussed upon, in contrast to its primary counterpart. Patients prefer that it is treated promptly, even when it is not life-threatening. Intensity of blood loss, and the lesser popularity of conservative management drive clinicians towards the active options. Remarkably, none of the current treatment options is based on any evidence. Suction evacuation of the uterus may be complicated by life-threatening complications and blood transfusion. There are a few guidelines, and probably no protocols. In this review, we highlight salient factors to take into consideration, and propose a locally adaptable flowchart, which may be of use to General Practice doctors, Community Midwives and Obstetricians.
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Affiliation(s)
- Isaac A Babarinsa
- The Women's Centre, Gloucestershire Hospitals NHS Trust, Gloucester GL1 3NN, United Kingdom.
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Abstract
Pregnancy, childbirth, and the puerperium are hemostatically challenging to women with bleeding disorders. This article provides general recommendations for the management of pregnant women with inherited coagulation disorders. Each factor deficiency is discussed, providing an up-to-date review of the literature and, where possible, guidance about how to manage patients throughout pregnancy, delivery, and the puerperium. The factor deficiencies covered are inherited abnormalities of fibrinogen; deficiencies of prothrombin, factor (F)V, FVII, FX, FXI, FXIII; combined deficiencies of FV and FVIII; and the inherited deficiency of vitamin K-dependent clotting factors. The management of carriers of hemophilia A and B is also discussed.
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Affiliation(s)
- Gillian N Pike
- Department of Clinical Haematology, Manchester Royal Infirmary, Manchester, UK
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HUQ FY, KADIR RA. Management of pregnancy, labour and delivery in women with inherited bleeding disorders. Haemophilia 2011; 17 Suppl 1:20-30. [DOI: 10.1111/j.1365-2516.2011.02561.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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