PRE-OPERATIVE ASSESSMENT

CLINICAL PRACTICE GUIDELINES
Hemophilia and von Willebrand's disease: 2. Management
(Edition 2, Update 2 [1999-07-07])

Major surgical procedures require consultation between the surgeon and the hematologist, and should be undertaken only in centres where specific facilities including a coagulation laboratory, blood bank, and expertise in hemophilia care exists. Major surgery can be performed safely in patients without inhibitors when adequate coverage by coagulation factor replacement therapy is provided. The implementation of the following recommendations during planning for major surgery may avert complications.

• A screen for factor inhibitors must be performed shortly before the surgical date.
• The patient should avoid using antiplatelet medication before and after surgery.
• Surgery should be scheduled for early in the week and early in the day to help ensure the availability of laboratory services and consultants.
• Adequate amounts of the coagulation factor replacement product to be used before and after surgery must be immediately available in the hospital blood bank or pharmacy.
• Availability of laboratory facilities for frequent and rapid coagulation factor assays must be ensured.

In the case of patients with significant levels of coagulation factor inhibitors, preparation for major surgery is more complicated and good hemostasis more difficult to attain. Decisions regarding surgery for these patients must be made after a careful weighing of the risks; surgery should be undertaken only after consultation with a hematologist experienced in managing patients with inhibitors.<40> Surgery for such patients should only be performed in a centre experienced in the surgical care of inhibitor patients.
Following major surgery, factor levels must be continuously maintained at hemostatic levels throughout the period of high risk.

Please click on the links below to find the full search methods for vWd.

EMBASE
PUBMED
CINAHL
CANCERLIT
WEB OF SCIENCE
iNTERNATIONAL PHARMASEUTICAL ABSTRCTS
MEDLINE
BIOLOGICAL ABSTRACTS