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Perioperative laboratory monitoring in congenital haemophilia patients with inhibitors

a systematic literature review

Hart, Daniel P.a; Hay, Charles R.M.b; Liesner, Ric; Tobaruela, Guillermod; Du-Mont, Bethane; Makris, Mikef

Blood Coagulation & Fibrinolysis: October 2019 - Volume 30 - Issue 7 - p 309–323
doi: 10.1097/MBC.0000000000000840

Although the use of clotting factor concentrates is the mainstay of haemophilia care, the development of inhibitors complicates disease management. Perioperative management of patients with inhibitors is therefore a challenge. A systematic literature review was performed to identify literature reporting on the perioperative monitoring and management of haemophilia. MEDLINE, Embase and Cochrane databases were searched from database inception to 26 March 2018. Recent congress proceedings were also searched. Titles and abstracts, then full texts, were screened for relevance by two reviewers. Quality of included studies was assessed using the Critical Appraisal Skills Programme checklist. Of the 2033 individual entries identified, 86 articles met the inclusion criteria. The identified studies were screened again to find articles reporting perioperative laboratory monitoring in patients with congenital haemophilia A or B, resulting in 24 articles undergoing data extraction. Routine perioperative assay monitoring practices were the most commonly reported (n = 20/24); thrombin generation assay was the least commonly reported (n = 2/24). Other monitoring practices described were factor VII and factor VIII coagulation activity (n = 8/24, n = 5/24, respectively), and thromboelastography or rotational thromboelastometry assessments (n = 3/24). The impact of monitoring on treatment decisions was, however, rarely reported. In conclusion, many methods of perioperative monitoring of haemophilia patients with inhibitors have been identified in this review, yet there is a lack of reporting in larger scale cohort studies. More detailed reporting on the impact of monitoring outcomes on treatment decisions is also needed to share best practice, particularly as new therapeutic agents emerge.

aThe Royal London Hospital Haemophilia Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London

bCentral Manchester University Hospitals Foundation Trust, Manchester

cGreat Ormond Street Hospital for Children NHS Foundation Trust, London

dRoche Products Ltd, Welwyn Garden City

eCostello Medical, Cambridge

fSheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, UK

Correspondence to Daniel P. Hart, The Royal London Hospital Haemophilia Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK E-mail:

Received 7 March, 2019

Revised 30 May, 2019

Accepted 9 July, 2019

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