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///2012 Abstract Details
2012 Abstract Details2019-08-02T19:38:42-05:00

Utilization of Thromboelastography prior to Neuraxial Anesthesia in a parturient with Von Willebrand’s Disease

Abstract Number: T-59
Abstract Type: Case Report/Case Series

Aoife Lane MD1 ; Saurin Shah MD2; Natesan Manimekalai MD3

Von Willebrand disease is a congenital coagulopathy affecting 1 to 2% of the general population and poses significant hemostatic challenges in the pregnant patient. [1] Type I von Willebrand is a partial, quantitative defect in von Willebrand factor with variable platelet dysfunction. The successful use of neuraxial anesthesia in patients with Von Willebrand’s disease has been reported, most being performed in patients with type 1 disease. [2]

Case:18 year old G1P0 parturient with a history of type 1 Von Willebrand’s disease presented in spontaneous labor at 37 weeks gestation. Platelet count was 257,000 and partial thromboplastin time was 12.9 seconds with a hemoglobin of 10g/dl. Given the significant time lag associated with the laboratory evaluation of factor VIII levels, thromboelastography was utilized to further evaluate coagulation status. This yielded a TEG R value of 4.5, a K value of 1, a TEG angle of 74.9 and a TEG maximum amplitude of 74.4, indicating a hypercoagulable state. This was subsequently confirmed by a concurrent factor VIII level. Epidural anesthesia was unremarkable with a loss of resistance to saline to the epidural space of 5cm, with a total duration of seven hours and further coagulation screening, TEG and factor VIII levels were performed prior to subsequent catheter removal.

Discussion: Thromboelastography (TEG) is a point of care rapid whole blood coagulation test allowing for a “real time” interpretation of the coagulation system [3]. TEG has not been validated in the evaluation of the risk of epidural hematoma, however it a been utilized in the assessment of von Willebrand’s disease in other clinical scenarios. [4] We utilized TEG to provide additional clinical information regarding the patient’s coagulation status, which would not have been available with other standardized laboratory testing.

Conclusion: The use of TEG could be considered as either an adjunct or as a potential alternative to factor VIII level determination in von Willebrand’s disease prior to neuraxial anesthesia.

Reference:

1. James AH, Kouides PA et al. Von willebrand disease and other bleeding disorders in women: Consensus on diagnosis and management from an international expert panel. Am J Obstet Gynecol 2009;201(1): 12.e1-12.e8.

2. Choi S, Brull R. Neuraxial techniques in obstetric and non-obstetric patients with common bleeding diatheses. Anesth Analg 2009;109(2): 648-660.

3. Schreiber MA. Coagulopathy in the trauma patient. Curr Opin Crit Care 2005;11(6): 590-597.

4. Pivalizza EG. Perioperative use of the thrombelastograph in patients with inherited bleeding disorders. J Clin Anesth 2003;15(5): 366-370.

SOAP 2012