title: Spanish consensus guidelines on prophylaxis with bypassing agents for surgery in patients with haemophilia and inhibitors.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Haematology Department, Hospital Regional Universitario de Málaga, Málaga, Spain.
authors.forename: María Eva
authors.initials: ME
authors.lastname: Mingot-Castellano
authors.affiliation: Thrombosis and Haemostasis Unit, Hospital Universitario La Paz., Madrid, Spain.
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Álvarez-Román
authors.affiliation: Haematology Department, Complejo Hospitalario Universitario A Coruña, A Coruna, Spain.
authors.forename: María Fernanda
authors.initials: MF
authors.lastname: López-Fernández
authors.affiliation: Haemophilia Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Altisent-Roca
authors.affiliation: Haematology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
authors.forename: Mariana Isabel
authors.initials: MI
authors.lastname: Canaro-Hirnyk
authors.affiliation: Thrombosis and Haemostasis Unit, Hospital Universitario La Paz., Madrid, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Jiménez-Yuste
authors.affiliation: Thrombosis and Haemostasis Unit, Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Ana Rosa
authors.initials: AR
authors.lastname: Cid-Haro
authors.affiliation: Haemophilia Unit, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Pérez-Garrido
authors.affiliation: Haematology Department, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Sedano-Balbas
mesh_terms: D000367:Age Factors; D019468:Disease Management; D005169:Factor VIII / Q000009:adverse effects / Q000276:immunology* / Q000627:therapeutic use; D015942:Factor VIIa / Q000008:administration & dosage / Q000009:adverse effects / Q000187:drug effects; D006467:Hemophilia A / Q000150:complications* / Q000188:drug therapy / Q000276:immunology*; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control* / Q000601:surgery; D006801:Humans; D007518:Isoantibodies / Q000276:immunology*; D019637:Orthopedic Procedures; D011292:Premedication; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000187:drug effects; D019233:Retreatment; D013514:Surgical Procedures, Operative / Q000379:methods; D061665:Time-to-Treatment
chemical_list: D007518:Isoantibodies; D011994:Recombinant Proteins; D005169:Factor VIII; C103587:recombinant FVIIa; D015942:Factor VIIa
keywords: consensus; inhibitors; prophylaxis; surgery haemophilia