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Poster: 91
Visits: 119
Title: Gynaecological and obstetrical bleeding in women with factor XI deficiency - a systematic review
Authors: Sophie Wiewel-Verschueren , I.J. Arendz, H.M. Knol and K. Meijer
Centre: Division of Thrombosis and Haemostasis, Department of Hematology, University of Groningen, University Medical Center Groningen
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GYNAECOLOGICAL AND OBSTETRICAL BLEEDING IN WOMEN WITH FACTOR XI DEFICIENCY - A SYSTEMATIC REVIEW
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 | | Sophie Wiewel-Verschueren |
Thread initiator
Subspeciality
Reg: 4/18/2014 9:32:00 AM
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Comment# 1
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Individuals with factor XI (FXI) deficiency are prone to bleed excessively during and/or after surgery and particularly in areas of high fibrinolysis such as the mouth and genitourinary system. Pregnancy, menstrual bleeding and delivery present an intrinsic haemostatic challenge to women with bleeding disorders such as FXI deficiency. We provide a systemic overview of studies in which gynaecological and obstetrical bleeding problems in women with FXI deficiency are discussed.We searched MEDLINE, EMBASE and the Cochrane library to identify studies that focus on the incidence, the levels and treatment options in FXI deficient women with gynaecological and obstetrical bleeding. Papers were eligible if they presented original data in adults. We excluded case reports and case series with 5 cases of FXI deficient patients. The articles were read independently by two reviewers. We identified 20 studies, with a total of 300 women with FXI deficiency (factor XI 70 U/dL). More than half of the patients had a mild deficiency (FXI &8805; 20 U/dL). Heavy menstrual bleeding (HMB) was reported in 29-41 (range within studies) of the women with FXI deficiency. In women who underwent gynaecological procedures, 7 out of 18 had a bleeding complication. Seven hysterectomies were performed, two women had bleeding complications. During pregnancy FXI levels do not increase. 2.8-20 of reported pregnancies ended in a miscarriage; of these miscarriages 0-25 (4 of 24) were complicated by a bleeding. Four out of 11 of the terminations of pregnancies (TOP) were complicated by bleeding. In 83 out of 424 deliveries, post partum haemorrhage (PPH) was reported, ranging from 0-40. In only 21 of the deliveries the patient received prophylaxis, 11 of those had PPH. In the 44 times epidural analgesia was performed, with or without prophylaxis, no complications were reported. Women with factor XI deficiency have a clearly increased risk of HMB, and bleeding complications after miscarriage, TOP and delivery. Despite high bleeding risks, in the majority of reported surgeries and deliveries, no prophylactic treatment was given.
Comment added on 4/18/2014 9:32:00 AM
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