Hematologic management of hemophilia A for surgery

• Published in: JAMA : the journal of the American Medical Association Vol. 253; no. 9; p. 1279
• Main Authors: Kasper, C K, Boylen, A L, Ewing, N P, Luck, Jr, J V, Dietrich, S L
• Format: Journal Article
• Language: English
• Published: United States 01.03.1985
• Subjects: Adolescent; Adult; Child; Factor VIII - administration & dosage; Factor VIII - analysis; Half-Life; Hemophilia A - blood; Hemophilia A - complications; Hemorrhage - etiology; Humans; Male; Middle Aged; Postoperative Care; Postoperative Complications - etiology; Surgical Procedures, Operative; Time Factors
• ISSN: 0098-7484
• DOI: 10.1001/jama.1985.03350330077026

From mid-1967 to mid-1983, three hundred fifty surgical operations were performed on 163 patients with hemophilia A, without factor VIII inhibitor. One death occurred, in a patient with a serious head injury. Postoperative hemorrhages occurred after 23% of operations, but the incidence after surgery on the knee, 40%, was decidedly higher than the 15% incidence after operations at other sites. Concurrent plasma factor VIII levels were over 0.40 units/mL in 72% of instances and under 0.30 units/mL in only 15% of instances. The incidence of postoperative hemorrhage did not change over the study period despite a threefold increase in typical dosage of factor VIII (from 600 to 2,000 units/kg per operation) and doubling of typical trough factor VIII levels (from 0.37 units/mL to 0.70 units/mL). Circulating factor VIII levels apparently are not the sole determinants of postoperative bleeding in hemophilia A.