title: Surgery in patients with hemophilia: is thromboprophylaxis mandatory?
abstract: Patients with hemophilia are considered low risk for thromboembolic complications. However, in the presence of risk factors for thrombosis, such as surgical procedures, and intensive replacement therapy this complication has been reported. Major orthopedic surgeries are often required in patients with hemophilia, due to the presence of hemophiliac arthropathy. In individuals that do not have hemophilia, orthopedic surgeries are particularly well recognized as high risk for venous thromboembolism, and the use of thromboprophylaxis for this condition is recommended. However, for hemophilia patients the use of venous thrombosis prophylaxis during major surgeries, including orthopedic procedures remains controversial. For the majority of the patients the use of gradated compression stockings and early mobilization can be sufficient to prevent venous thromboembolism. The use of anticoagulant prophylaxis should be considered just for patients with relevant additional risk factor for thrombosis. However, for hemophilia patients with inhibitor, pharmacologic thromboprophylaxis is not recommended. For patients with von Willebrand disease receiving factor concentrates replacement therapy undergoing surgical procedures, the FVIII plasma levels should be monitored and thromboprophylaxis should be considered if any other thrombosis risk factor is present. It is important for the future to establish risk assessment tools that can help to determine the most effective and safe practice to prevent venous thrombosis in patients with hemophilia and other bleeding disorders who undergo surgical procedures.
authors.affiliation: INCT do Sangue Hemocentro UNICAMP, University of Campinas, Campinas, SP, Brazil. margaret@unicamp.br
authors.forename: Margareth C
authors.initials: MC
authors.lastname: Ozelo
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D001777:Blood Coagulation / Q000187:drug effects* / Q000235:genetics; D003661:Decision Support Techniques; D004434:Early Ambulation; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006467:Hemophilia A / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000235:genetics; D006801:Humans; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D053828:Stockings, Compression; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000097:blood / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents