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Pregnancy in women with Factor XI deficiency ( < 60 UI/dL) and use of neuraxial analgesia : real life data in a French cohort of 314 pregnancies

1laboratoire de biologie médicale- secteur hémostase - André Mignot hospital, Versailles, Le Chesnay, Ile-de-France, France, 2Service d’hématologie biologique - AP-HP.Centre-Université de Paris, hôpital Bichat, Paris, Ile-de-France, France, 3University Hospital of Nantes, Nantes, Pays de la Loire, France, 4Service d’hématologie biologique, Hôpital Bicêtre, APHP, Université Paris-Saclay, Le Kremlin-Bicêtre, Ile-de-France, France, 5Service d’hématologie biologique, AP-HP.Centre-Université de Paris, hôpital Necker, Paris, Ile-de-France, France, 6Normandie Univ, UNIROUEN, INSERM U1096, Vascular Hemostasis Unit, Rouen University Hospital, France, Rouen, Haute-Normandie, France, 7CHU BECLERE APHP, Clamart, Ile-de-France, France, 8Laboratoire de biologie médicale, centre hospitalier de Valencienne, Valencienne, Nord-Pas-de-Calais, France, 9Service d’hématologie biologique, CHU Clermont-Ferrand, Clermont-Ferrand, France, Clermont-Ferrand, Rhone-Alpes, France, 10Service d’hématologie biologique, Centre hospitalier universitaire de Montpellier, Montpellier, Languedoc-Roussillon, France, 11CRC-MHC, Hôpital de Bicetre AP-HP, Le Kremlin Bicetre, France, Le Kremlin Bicêtre, Ile-de-France, France, 12Hospices Civils de Lyon. - Unité d'Hémostase Clinique, Hôpital Cardiologique, Bron, Rhone-Alpes, France, 13Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon, LYON, Rhone-Alpes, France, 14Lille University Hospital, Lille, Nord-Pas-de-Calais, France, 15Centre de ressources et compétences des Maladies Hémorragiques Constitutionnelles rares, Centre hospitalier universitaire d’Angers, Angers, Pays de la Loire, France, 16Centre de ressources et compétences des Maladies Hémorragiques Constitutionnelles rares, Centre hospitalier universitaire de Dijon, Dijon, Bourgogne, France, 17Hospices Civils de Lyon. Centre de Référence de l’Hémophilie et des Maladies Hémorragiques Constitutionnelles rares - Unité d'Hémostase Clinique, Hôpital Cardiologique, Bron, Rhone-Alpes, France, 18Centre de Ressources et de Compétences des Maladies Hémorragiques Constitutionnelles rares, AP-HP.Centre-Université de Paris, Hôpital Cochin, Paris, Ile-de-France, France, 19Centre de ressources et compétences des Maladies Hémorragiques Constitutionnelles rares, centre hospitalier de Versailles (André Mignot), Le chesnay, Ile-de-France, France

Abstract Number: PB0706

Meeting: ISTH 2022 Congress

Theme: Hemophilia and Rare Bleeding Disorders » Rare Bleeding Disorders

Background: Factor XI (FXI) deficiency is a rare bleeding disorder with a poor correlation between bleeding tendency and FXI level. Management of pregnant women with FXI deficiency is not established, especially regarding neuraxial analgesia (NA). In 2018, the CoMETH group conducted a national survey among French physicians (32 centers) showing heterogenous practices regarding the FXI threshold to allow NA, ranging from 30 to 60UI/dL.

Aims: Here, we report a new study of a large French cohort of pregnant women with FXI deficiency (FXI < 60UI/dL), in order to assess FXI levels used to achieve NA in real life practice.

Methods: An on-line questionnaire was sent to French haemostasis centres. The objectives were to report (i) FXI levels before pregnancy and at term of delivery in women with FXI deficiency who underwent NA, (ii) delivery management modalities and (iii) possible complications related to the NA.

Results: : 314 pregnancies with FXI deficiency were included (from 20 centres), 200 NA have been completed (137 epidural and 61 spinal, one had both). The period of childbirth was mostly from 2014 to 2020 (89.5%). Congenital FXI deficiency was confirmed in 32.8% (n=103; 27/103 genotyped). Previous bleedings were described in 19.75% (49.2% cutaneous, 33.9% gynaecological, 17% post-surgical). FXI level at delivery and mode of delivery are presented in table 1. Median FXI levels in the epidural and spinal group are not significantly different. 18 deliveries had a NA with FXI < 30 UI/dL, of which 6 women received FXI concentrates. 42 deliveries had NA with FXI [30-40 UI/dL] and 119 with FXI [40-60 UI/dL]. There were no complications related to NA.

Conclusion(s): We describe here the largest cohort in FXI deficiency pregnant women’s, to our knowledge. The results confirm that a 30UI/dL FXI threshold is safe for NA. This is consistent with the French recommendations published in august 2021 (PNDS 2021).

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To cite this abstract in AMA style:

Flaujac C, Cavalie C, Drillaud N, Lavenu-Bombled C, Timsit S, Billoir P, Desconclois C, Touzet L, Lebreton A, Diaz-Cau I, d'Oiron R, Giansily-Blaizot M, Fretigny M, Desage S, Wibaut B, Beurrier P, Volot F, Rugeri L, Roussel-Robert V, de Raucourt E. Pregnancy in women with Factor XI deficiency ( < 60 UI/dL) and use of neuraxial analgesia : real life data in a French cohort of 314 pregnancies [abstract]. https://abstracts.isth.org/abstract/pregnancy-in-women-with-factor-xi-deficiency-60-ui-dl-and-use-of-neuraxial-analgesia-real-life-data-in-a-french-cohort-of-314-pregnancies/. Accessed October 1, 2023.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/pregnancy-in-women-with-factor-xi-deficiency-60-ui-dl-and-use-of-neuraxial-analgesia-real-life-data-in-a-french-cohort-of-314-pregnancies/