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Spanish consensus guidelines on prophylaxis with bypassing agents for surgery in patients with haemophilia and inhibitors
Author(s) -
MingotCastellano María Eva,
ÁlvarezRomán María Teresa,
LópezFernández María Fernanda,
AltisentRoca Carmen,
CanaroHirnyk Mariana Isabel,
JiménezYuste Víctor,
CidHaro Ana Rosa,
PérezGarrido Rosario,
SedanoBalbas Carmen
Publication year - 2016
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.12730
Subject(s) - medicine , haemophilia , haemophilia a , intensive care medicine , prophylactic treatment , surgery , medline , evidence based medicine , alternative medicine , political science , law , pathology
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. Aims 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 rFVII a) and should start immediately before minor or major surgery. Patients should be closely monitored to enable dose/product modification as needed. Conclusion 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.