Table 4 Management consensus for individuals with hemophilia
From: Cardiac surgery in patients with Hemophilia:is it safe?
Preoperative assessments | Classification of the disease Multidisciplinary team: surgery should be performed in hospitals that have a hemophilia treatment center Inhibitor measurements (Bethesda assay) |
|---|---|
Intra-operativetreatment | The factor level should be maintained above 80% at the end of surgery Factor transfusion should be managed by an experienced hematologist in the operating room Routine use of cell saver Routine use of TEG to monitor coagulation, especially during the process of heparin titration Antifibrinolytics during surgery Tissue valve should be preferred Maintain the factor level above 80% in the early 48 h post-operatively. |
Post-operativetreatment | Continues is better than bolus factor replacement Factor measurements twice daily in the morning and evening Factor level replacement above 50% after 48 h Inhibitor screening if clinically indicated Intensive physiotherapy treatment and early mobility to prevent thrombosis Low-dose aspirin prophylaxis for life |