The perioperative management of an adult woman with Sneddon syndrome is presented. This syndrome is characterized by vasculopathy hypercoagulable state, ischemic cerebral events, livedo reticularis, heart valve disease, and renal insufficiency. During surgery in these patients, the balance between bleeding and thrombosis requires rapid diagnostic information for therapeutic decisions. Thrombelastographic analysis may be a valuable tool to use in monitoring these patients. (C) 2008 Elsevier Inc. All rights reserved.