ArticleJournal of orthopaedic case reports2026
Real-Time Coagulation Monitoring via Thromboelastography and Platelet Mapping in Total Hip Arthroplasty for a Patient with Factor XI Deficiency: A Case Report.
Article in Journal of orthopaedic case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Factor XI deficiency (hemophilia C) presents significant perioperative challenges during major orthopedic procedures due to highly unpredictable bleeding phenotypes. Case Report: A 67-year-old female with severe hip osteoarthritis and Factor XI deficiency (baseline activity 63.4%) underwent total right hip arthroplasty. Despite pre-operative factor correction using Fresh Frozen Plasma, persistent intraoperative microvascular bleeding occurred. While standard thromboelastography showed normal clot kinetics, automated platelet mapping revealed severe inhibition in the adenosine diphosphate and arachidonic acid pathways, secondary to chronic, self-medicated non-steroidal anti-inflammatory drugs use. Prompt intraoperative platelet apheresis successfully achieved hemostasis. Post-operative recovery was uneventful following mechanical and pharmacological thromboprophylaxis. Conclusion: Standard coagulation profiles do not guarantee surgical hemostasis in patients with mild inherited coagulopathies. Point-of-care platelet mapping is an essential tool to identify hidden drug-induced platelet dysfunction, guiding targeted therapies and ensuring optimal surgical outcomes.
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