Controversies and challenges in elective orthopedic surgery in patients with hemophilia and inhibitors.
Until recently, orthopedic surgery was strongly contraindicated in patients with hemophilia and inhibitors. However, recent advances in our knowledge of bypassing agents (particularly recombinant activated factor VII [rFVIIa]) that provide effective surgical hemostasis have allowed us to successfully perform major orthopedic procedures in these patients. Adequate hemostasis during surgery and postoperative rehabilitation is crucial, as development of a wound hematoma may jeopardize long-term outcomes. It also should be noted that success depends not only on appropriate drug therapy but also on preoperative preparations and adequate perioperative surveillance. Preoperative assessment of vascular status is very important, and strong motivation--on the part of the patient, the surgeon, and the hematologist--is needed to ensure a satisfactory result. Although inhibitor patients undergoing surgery face a higher risk of bleeding and other complications than their non-inhibitor counterparts, outcomes are generally good if a multidisciplinary team approach is applied.
Jiménez-Yuste
Victor
V
Department of Hematology, Autonoma University, Madrid, Spain. vjimenez.hulp@salud.madrid.org
Rodriguez-Merchan
E Carlos
EC
Alvarez
Maria Teresa
MT
Quintana
Manuel
M
Fernandez
Ihosvany
I
Hernandez-Navarro
Fernando
F
D019774:Blood Coagulation Factor Inhibitors / Q000097:blood*; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D017558:Elective Surgical Procedures; D015942:Factor VIIa / Q000627:therapeutic use; D006467:Hemophilia A / Q000097:blood* / Q000150:complications; D006801:Humans; D016916:Joint Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D019637:Orthopedic Procedures; D011994:Recombinant Proteins / Q000627:therapeutic use
D019774:Blood Coagulation Factor Inhibitors; D001779:Blood Coagulation Factors; D011994:Recombinant Proteins; C103587:recombinant FVIIa; D015942:Factor VIIa