What is your perioperative approach for a patient with severe hemophilia?

The optimal management of people with hemophilia is complex. Planning for elective surgery should include the patient, family/caregivers, and all relevant clinicians to ensure that best practices are followed. Collaboration with experts from a hemophilia treatment center to develop a hemostatically effective and safe care plan is strongly advised.

The standard of care for preventing perioperative bleeding has been replacement therapy with FVIII concentrates. For patients with high-titer inhibitors bypassing agents such as emicizumab can be recommended. However, there is no consensus on the appropriate management. Decisions should be made in consultation with a hemophilia expert.

All the available products can produce satisfactory hemostasis. ...