Coagulation assessment with thromboelastography during abdominal endovascular aneurysm repair in a patient with hemophilia A.
Abdominal aortic aneurysm
Endovascular aortic repair
Factor VIII
Hemophilia A
Heparin
Heparinase
Thromboelastography
Viscoelastic
Journal
JA clinical reports
ISSN: 2363-9024
Titre abrégé: JA Clin Rep
Pays: Germany
ID NLM: 101682121
Informations de publication
Date de publication:
04 Feb 2020
04 Feb 2020
Historique:
received:
02
12
2019
accepted:
27
01
2020
entrez:
7
2
2020
pubmed:
7
2
2020
medline:
7
2
2020
Statut:
epublish
Résumé
As both APTT and APTT-based coagulation method cannot distinguish heparin effect from intrinsic coagulation factor deficiency, we implemented thromboelastography (TEG) for the coagulation assessment in a patient with hemophilia A undergoing an endovascular surgery with heparinization. A 68-year-old male with hemophilia A underwent endovascular aortic repair for abdominal aortic aneurism. TEG results showed recovery of coagulation time (R) in both kaolin assay (CK) and kaolin-heparinase assay (CKH) after factor VIII replacement before heparinization. Against our expectations, R-CKH was slightly prolonged (9.0 min) during heparinization. After the administration of protamine sulfate, R in both assays showed similar values within the normal ranges. The combination of CK and CKH assays could be useful to estimate factor VIII (FVIII) level when heparin concentration is low or without heparin; however, caution should be necessary for estimation of FVIII level by TEG under the effect of medium- or high-dose heparin.
Sections du résumé
BACKGROUND
BACKGROUND
As both APTT and APTT-based coagulation method cannot distinguish heparin effect from intrinsic coagulation factor deficiency, we implemented thromboelastography (TEG) for the coagulation assessment in a patient with hemophilia A undergoing an endovascular surgery with heparinization.
CASE PRESENTATION
METHODS
A 68-year-old male with hemophilia A underwent endovascular aortic repair for abdominal aortic aneurism. TEG results showed recovery of coagulation time (R) in both kaolin assay (CK) and kaolin-heparinase assay (CKH) after factor VIII replacement before heparinization. Against our expectations, R-CKH was slightly prolonged (9.0 min) during heparinization. After the administration of protamine sulfate, R in both assays showed similar values within the normal ranges.
CONCLUSIONS
CONCLUSIONS
The combination of CK and CKH assays could be useful to estimate factor VIII (FVIII) level when heparin concentration is low or without heparin; however, caution should be necessary for estimation of FVIII level by TEG under the effect of medium- or high-dose heparin.
Identifiants
pubmed: 32026972
doi: 10.1186/s40981-020-0316-0
pii: 10.1186/s40981-020-0316-0
pmc: PMC7000567
doi:
Types de publication
Journal Article
Langues
eng
Pagination
7Références
Semin Cardiothorac Vasc Anesth. 2017 Dec;21(4):312-320
pubmed: 28388863
Semin Thromb Hemost. 2017 Jun;43(4):386-396
pubmed: 28359133
Haemophilia. 2015 May;21(3):e232-5
pubmed: 25684019
J Cardiothorac Vasc Anesth. 2011 Dec;25(6):981-6
pubmed: 21315618
Blood Coagul Fibrinolysis. 2017 Jun;28(4):329-333
pubmed: 27273141
Haemophilia. 2008 Jul;14 Suppl 3:83-92
pubmed: 18510527
Am J Hematol. 2019 Feb;94(2):249-256
pubmed: 30328141
Haemophilia. 2008 Jul;14 Suppl 3:76-82
pubmed: 18510526
J Thromb Haemost. 2015 Jul;13(7):1279-84
pubmed: 25903848
TH Open. 2019 Sep 12;3(3):e295-e305
pubmed: 31523746