Factor XI deficiency: Implications for management of patients undergoing aesthetic surgery

We report our experience in patients with an abnormal partial thromboplasti n time elevation due to factor XI deficiency (Rosenthal syndrome) who prese nted for aesthetic surgery consideration. Preoperative evaluation included a thorough history, physical examination, coagulation profile, and hematolo gical consultation. Nine of 10 patients underwent 12 elective aesthetic pro cedures without undue intraoperative or postoperative bleeding. Based on th ese findings, we stratified patients as low risk or high risk. Low-risk pat ients were those with greater than 15 percent factor XI levels, or those wi th 5 to 14 percent factor XI levels but a history of multiple major surgica l procedures without bleeding complications. High-risk patients were those with factor XI levels less than 15 percent, history of bleeding either spon taneously or with surgery, and a family history of bleeding diathesis from factor XI deficiency. Low-risk patients had fresh frozen plasma available f or the procedure, whereas high-risk patients received fresh frozen plasma 2 hours before surgery. We conclude that (1) in these patients with abnormal ly high partial thromboplastin time values and no prior known bleeding diso rder, we have identified factor XI deficiency as the prevalent coagulopathy ; (2) partial thromboplastin time does not necessarily correlate with facto r XI levels; (3) patients can be classified as high or low risk for electiv e surgery based on factor XI levels and prior surgical or family history; ( 4) recommendations for perioperative management can be made based on this r isk profile; and (5) aesthetic surgery can be performed successfully and sa fely on patients with factor XI deficiency on a case-by-case basis when app ropriate guidelines are enforced.