Managing Preoperative Hemostasis in Patients with Inherited and Acquired Bleeding Disorders

Abstract

Inherited and acquired bleeding disorders pose significant hemostatic challenges for surgery. Patients at particular risk of bleeding include those with inherited bleeding disorders such as hemophilia, von Willebrand disease, and platelet function defects; those on antiplatelet agents or anticoagulants; and those with acquired conditions such as immune thrombocytopenic purpura, liver disease, or renal impairment. Each has its own specific challenges and close collaboration between the anesthetic, surgical, and hematology teams is crucial. Optimizing surgical hemostasis for patients at risk involves attention to detail, with careful preoperative planning, meticulous surgical technique, prompt identification of complications and judicious use of hemostatic agents and blood components. This article gives an overview of the bleeding risks involved and therapeutic options to overcome them.

Clinical Outcomes and Surgical Complications Among Patients with Bleeding Disorders After Acute Hip Fracture Surgery

“…Nevertheless, these patients are linked together by their coagulopathic state regardless of whether a bleeding disorder is inherited or acquired as both etiologies pose similar hemostatic challenges for surgery. 37,38 Finally, NSQIP only provides data up to 30 days after surgery. Longterm sequelae of bleeding disorders were not examined in this study.…”

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“…2 There are other special groups of patients who require extra consideration prior to surgery and they include those with inherited and acquired bleeding disorders and their management is discussed by Mensah and Pavord. 3 However, the largest groups with preexisting coagulopathies are those who are taking antithrombotic medication. Nikolakopoulos and Spyropoulos discuss how these patients should be bridging anticoagulation based on current evidence.…”