The Impact of Inhibitors on Surgical Management in Patients With Hemophilia

The presence of inhibitors in patients with hemophilia can complicate surgical management, leading to higher risks of bleeding and deviations from the original treatment plan according to a study published in Research and Practice in Thrombosis and Haemostasis. 

The development of inhibitors to clotting factors can make managing hemophilia A and B more difficult, often requiring the use of bypassing agents to control bleeding. This study aims to assess how the presence of inhibitors impacts perioperative hemostasis, the development of complications, and adherence to the presurgical plan.

A retrospective study using data collected between 1998 and 2019 from the Indiana Hemophilia and Thrombosis Center surgical database examined associations between perioperative outcomes and inhibitor status in 539 persons with hemophilia. 

Of the 1492 surgeries performed, 72 were in patients with inhibitors. High and low-responding inhibitors were present in different proportions of procedures, with historically persistent inhibitors in others. Inhibitors were associated with a higher risk of inadequate perioperative hemostasis but reported complications did not differ based on inhibitor status. Surgeries involving inhibitors were more likely to have presurgical plan deviations, such as hemostatic medication dose adjustments and changes in postoperative hospitalization.

“Inhibitors are associated with higher risks of adverse perioperative outcomes,” said researchers. “Strategies to address inhibitor development should be prioritized to avoid undesirable perioperative outcomes.”

Reference 
Olasupo OO, Nakar C, Haddix C, et al. Inhibitors in hemophilia: association with surgery plans and outcomes in a retrospective cohort study. Res Pract Thromb Haemost. 2003;7(7):102228. doi:10.1016/j.rpth.2023.102228