Evaluating coagulation status with thromboelastography in a woman with antiphospholipid syndrome and sepsis: a case...

This study presents the case of a pregnant woman with antiphospholipid syndrome (APS) who developed septic shock after labor induction. Prolonged coagulation times suggested a hypocoagulable state and contraindication to anticoagulation. Thromboelastography (TEG) similarly indicated hypocoagulation. To exclude the impact of lupus anticoagulant on the coagulation assays, a mixing test of prolonged activated partial thromboplastin times was conducted. The mixing test confirmed that prolongation of coagulation times in vitro was affected by antiphospholipid antibodies (aPL), such as lupus anticoagulant. The patient was administered human immunoglobulin and low-molecular weight heparin to neutralize antibodies and for anticoagulation, respectively. The patient's coagulation state significantly improved. Based on these findings, anesthesiologists and obstetricians should be aware that TEG might not be a reliable method of correcting coagulation parameters in patients with sepsis in the presence of aPL. If necessary, a mixing test can be performed to correctly define a patient's coagulation status.