Thromboelastography-Guided Anesthetic Management for Cesarean Section in a Patient With Antiphospholipid Syndrome: A Case Report

In pregnant women with antiphospholipid syndrome (APS) receiving subcutaneous unfractionated heparin, activated partial thromboplastin time (aPTT) cannot reliably evaluate anticoagulant effects due to interference from antiphospholipid antibodies. Thromboelastography (TEG) can assess both heparin effects and overall coagulation status. A pregnant woman with APS on aspirin and subcutaneous unfractionated heparin developed genital bleeding, necessitating an emergency cesarean section. The interval since the last heparin dose was borderline for safe neuraxial anesthesia. TEG was performed to evaluate coagulation status and revealed impaired coagulation, likely due to residual heparin effect and reduced coagulation factors from bleeding. General anesthesia was selected. Surgery proceeded uneventfully under general anesthesia with intraoperative transfusion of fresh frozen plasma. Hemostasis was maintained perioperatively. TEG provided critical information for anesthesia decision-making and intraoperative management in a pregnant patient with APS receiving heparin, helping guide safe and effective clinical care.