Abstract
BackgroundAs 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 presentationA 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.ConclusionsThe 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.
Highlights
As both Activated partial thromboplastin time (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: A 68-year-old male with hemophilia A underwent endovascular aortic repair for abdominal aortic aneurism
The combination of CK and CKH assays could be useful to estimate factor VIII (FVIII) level when heparin concentration is low or without heparin; caution should be necessary for estimation of FVIII level by TEG under the effect of medium- or high-dose heparin
FVIII:C1 is most broadly used in many hospitals, including ours, because it is simple and is recommended as a perioperative assay by the guidelines [2], it may underestimate the FVIII level in heparinized blood because some of intrinsic coagulation factors other than FVIII are inhibited by heparin-bound antithrombin [5]
Summary
The combination of CK and CKH assays could be useful to estimate factor VIII (FVIII) level when heparin concentration is low or without heparin; caution should be necessary for estimation of FVIII level by TEG under the effect of medium- or high-dose heparin.
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