PB0706 - 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

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Claire Flaujac

Hematologist
laboratoire de biologie médicale- secteur hémostase - André Mignot hospital, Versailles
Le Chesnay, Ile-de-France, France

Co-Author(s)

CC

Candice Cavalie

Hematologist
Service d’hématologie biologique - AP-HP.Centre-Université de Paris, hôpital Bichat
Paris, Ile-de-France, France
ND

Nicolas Drillaud

MD
CRC-MHC, CHU Hôtel-Dieu
Nantes, Pays de la Loire, France
CL

Cecile Lavenu-Bombled

Hematologist
Service d’hématologie biologique, Hôpital Bicêtre, APHP, Université Paris-Saclay
Le Kremlin-Bicêtre, Ile-de-France, France
ST

Sarah Timsit

Hematologist
Service d’hématologie biologique, AP-HP.Centre-Université de Paris, hôpital Necker
Paris, Ile-de-France, France
pb

paul billoir

Pharm D, PhD
university hospital of rouen
Rouen, Haute-Normandie, France
CD

Céline Desconclois

MD
Biological Hematology, Antoine Béclère Hospital, AP-HP, Paris-Saclay University, Clamart, France
Clamart, Ile-de-France, France
LT

Lucas Touzet

Hematologist
Laboratoire de biologie médicale, centre hospitalier de Valencienne
Valencienne, Nord-Pas-de-Calais, France
AL

Aurélien Lebreton

MD
Service d’hématologie, CHU Clermont-Ferrand, Hôpital Estaing
Clermont Ferrand, Auvergne, France
ID

Isabelle Diaz-Cau

Hematologist
Service d’hématologie biologique, Centre hospitalier universitaire de Montpellier
Montpellier, Languedoc-Roussillon, France
RD

Roseline D'Oiron

Hematologist
Haemophilia Treatment Centre, Bicêtre Hospital, University Hospital of Paris (APHP), Kremlin-Bicêtre, France.
paris, Centre, France
MG

Muriel Giansily-Blaizot

Hematologist
Service d’hématologie biologique, Centre hospitalier universitaire de Montpellier
Montpellier, Languedoc-Roussillon, France
MF

Mathilde Fretigny

PharmD
Hospices Civils de Lyon, Groupe Hospitalier Est, Service d’hématologie biologique, Bron, France
LYON, Rhone-Alpes, France
Stéphanie Desage, MD

Dr
Hôpital cardiologique Louis Pradel, Hospices Civils de Lyon
LYON, Rhone-Alpes, France
BW

Benedicte Wibaut

MD
Lille University Hospital
Lille, Nord-Pas-de-Calais, France
PB

Philippe Beurrier

MD
Hemophilia Treatment Center, Vascular and Coagulation Clinic, University Hospital Angers, France
Angers, Pays de la Loire, France
FV

Fabienne Volot

MD
Dijon University Hospital, Hemostasis Clinical Center, Dijon, France
Dijon, Bourgogne, France
LR

Lucia Rugeri

Hematologist
Hospices 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
VR

Valérie Roussel Robert

Doctor
Centre de Ressource et de Competences-Maladies Hemorragiques Constitutionnelles, Hopital Cochin APHP.Centre
Paris, Ile-de-France, France
Ed

Emmanuelle de Raucourt

Hematologist
Centre de ressources et compétences des Maladies Hémorragiques Constitutionnelles rares, centre hospitalier de Versailles (André Mignot)
Le chesnay, Ile-de-France, France

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).