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Eur J Haematol. 2016 May;96(5):461-74. doi: 10.1111/ejh.12730. Epub 2016 Feb 4.

Spanish consensus guidelines on prophylaxis with bypassing agents for surgery in patients with haemophilia and inhibitors.

Author information

1
Haematology Department, Hospital Regional Universitario de Málaga, Málaga, Spain.
2
Thrombosis and Haemostasis Unit, Hospital Universitario La Paz., Madrid, Spain.
3
Haematology Department, Complejo Hospitalario Universitario A Coruña, A Coruna, Spain.
4
Haemophilia Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
5
Haematology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
6
Thrombosis and Haemostasis Unit, Hospital Universitario La Fe, Valencia, Spain.
7
Haemophilia Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
8
Haematology Department, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain.

Abstract

INTRODUCTION:

Patients with severe haemophilia and inhibitors against factor VIII who require surgery need a prophylactic approach to prevent bleeding complications. Scientific evidence to decide the best prophylactic treatment is very limited and mainly based on retrospective or case series.

AIMS:

To develop evidence- and expert opinion-based guidelines for prophylactic therapy for patients with haemophilia and inhibitors undergoing surgery.

METHODS:

A panel of nine Spanish haematologists undertook a systematic review of the literature and selected publications providing relevant information regarding the prophylactic management of patients with haemophilia and inhibitors undergoing dental extraction, minor surgery or major surgery.

RESULTS:

Although evidence is very limited, the panel considers that it seems advisable that prophylaxis should be given in most cases with a bypassing agent (aPCC or rFVIIa) and should start immediately before minor or major surgery. Patients should be closely monitored to enable dose/product modification as needed.

CONCLUSION:

It is necessary to communicate clinical experience in a detailed way in order to ensure optimal schemes of prophylaxis for patients with haemophilia and inhibitors. Development of objective outcomes to evaluate efficacy is crucial.

KEYWORDS:

consensus; inhibitors; prophylaxis; surgery haemophilia

PMID:
26714021
DOI:
10.1111/ejh.12730
[Indexed for MEDLINE]

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