“The successful surgical management of patients with hemophilia requires advanced preoperative planning. A formal treatment plan should be determined and distributed well in advance of any invasive procedure or surgery and is best done under the guidance of a hemophilia treat ment center (HTC).”

“Prior to surgery, the patient’s diagnosis should be confirmed with laboratory testing, rather than prior patient report. It is particularly important to differentiate severe von Wille
brand’s disease from hemophilia A. A preoperative history should include a review of baseline hemostatic needs that considers the frequency of breakthrough bleeding and the use of prophylactic and breakthrough hemostatic agents as well as surgical history, prior use of hemostatic support, and any bleeding complications.”

Key points

• “Periprocedural hemostatic treatment plans should include the patient’s diagnosis, the type of surgery, the timing and need for lab monitoring, and plans for hemostatic support
  both preoperatively and postoperatively, including frequency, duration, and location of CFC infusions.”
• “Each patient should be carefully assessed for comorbidities and exposures that may increase bleeding and thrombotic risks”.
• “For minor surgical procedures, patients should have peak factor levels of 50% to 80% prior to the procedure and factors levels of 30% to 80% for the first 1 to 5 postoperative days.
  For major surgeries, peak factors levels should be 80% to 100% prior to the procedure (with gradual reduction in peak factor level goals over the first 14 postoperative days).”

Poston, Jacqueline N, and Rebecca Kruse-Jarres. “Perioperative hemostasis for patients with hemophilia.” Hematology. American Society of Hematology. Education Program vol. 2022,1 (2022): 586-593.