Perioperative ROTEM® evaluation in a patient affected by severe VII factor deficiency undergoing microvascular...

Area of Science:

• Coagulation Medicine
• Neurosurgery
• Rare Bleeding Disorders

Background:

• Assessing bleeding risk in rare coagulation disorders like Factor VII deficiency is challenging due to discrepancies between lab results and clinical presentation.
• Viscoelastic testing (TEG/ROTEM®) has not been previously studied for coagulation assessment in Factor VII deficient patients undergoing neurosurgery.

Observation:

• A patient with severe Factor VII deficiency undergoing microvascular decompression craniotomy presented with normal ROTEM® results pre- and post-recombinant activated FVII administration.
• Standard coagulation tests indicated a coagulopathy, which improved with replacement therapy, contrasting with ROTEM® findings.

Findings:

• ROTEM® did not detect significant coagulopathy in this Factor VII deficient neurosurgical patient, despite standard tests showing a correctable disorder.
• A notable reduction in EXTEM and FIBTEM Clotting Times was observed post-treatment, though overall ROTEM® values remained within normal ranges.

Implications:

• The study highlights a potential inadequacy of current thromboelastographic normal ranges for Factor VII deficiency or suggests the absence of clinically significant coagulopathy despite lab values.
• More data is crucial to define the perioperative role of viscoelastic tests in managing Factor VII deficient patients undergoing high-risk neurosurgical procedures.