• J Davies, A Harper, and R A Kadir.
• Katharine Dormandy Haemophilia Centre and Thrombosis Unit, Department of Obstetrics and Gynaecology, Royal Free Hospital NHS Foundation Trust, Hampstead, London, UK.
• Haemophilia. 2016 Mar 1; 22 (2): 276-284.

IntroductionWomen with factor XI (FXI) deficiency are at an increased risk of bleeding complications at delivery. Obstetric management is complicated by a lack of correlation between FXI level and bleeding risk.AimThe aims of this study were to assess the difference in rotational thromboelastometry (ROTEM® ) in parturient women with FXI deficiency compared to parturient and non-parturient controls and to evaluate the usefulness of ROTEM® in assessing bleeding risk at delivery in women with FXI deficiency.MethodsROTEM® was performed on 60 women: 27 with FXI deficiency, 20 age-matched parturient controls and 12 non-parturient controls. Pregnancy outcomes and haemostatic cover was reviewed in 57 deliveries of women with FXI deficiency.ResultsWomen with FXI deficiency had a longer clotting time (CT) and clot formation time (CFT) (P < 0.001), reduced alpha angle (P < 0.001) but no difference in MCF (P = 0.054) compared to parturient controls. Compared to non-parturient controls, they had a longer CT (P < 0.001), but shorter CFT (P < 0.001), increased alpha angle (P < 0.001) and increased MCF (P = 0.005). ROTEM® was an additional helpful parameter in managing parturient women with FXI deficiency, reducing the need for factor administration.ConclusionROTEM® demonstrated hypercoagulable changes during pregnancy in women with FXI deficiency. However, they took longer to clot compared to parturient controls, but had increased clot consolidation and clot strength compared to non-parturient controls. ROTEM® is an additional test that is helpful to assess bleeding risk and provision of appropriate haemostatic cover at delivery.© 2015 John Wiley & Sons Ltd.

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