Moderate factor XI deficiency and neuraxial procedures in an obstetric cohort: a retrospective study (2014-2021)

Abstract

Background: Factor XI (FXI) deficiency is a rare inherited bleeding disorder potentially associated with an increased risk of bleeding, particularly in traumatic or surgical situations. The correlation between FXI levels and bleeding risk is weak, leading to ongoing debate regarding the FXI threshold for authorizing neuraxial procedures in obstetric patients. We report data on a cohort of pregnant women with FXI deficiency.

Methods: This retrospective study included all pregnant women admitted to two high-risk obstetric departments between 2014 and 2021, with FXI levels ≤0.50 IU/mL from the start of pregnancy to postpartum day 1. Data recorded included demographic information, obstetrical history, characteristics of the current pregnancy, personal and familial bleeding history, and biological results.

Results: A total of 101 women (107 deliveries) were included in this analysis, of which 67 delivered with neuraxial labor analgesia or cesarean anesthesia. All but one had a FXI level >0.30 IU/mL, and 9/67 (13%) reported a bleeding history. No hemorrhagic complications related to neuraxial anesthesia were reported.

Conclusion: Our findings are consistent with previous reports of positive outcomes after neuraxial procedures in pregnant women with FXI level >0.30 IU/mL, with a thorough review of personal and family bleeding history.

Keywords: Bleeding; Blood coagulation disorder; Delivery; Factor XI deficiency; Neuraxial analgesia.