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.
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