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Semin Thromb Hemost 2020; 46(01): 017-025
DOI: 10.1055/s-0039-3402425
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Managing Preoperative Hemostasis in Patients with Inherited and Acquired Bleeding Disorders

Patrick Kyei Mensah
1   Haemostasis and Thombosis Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
,
Sue Pavord
2   Department of Haematology, Oxford University Hospitals NHS FT, Oxford, United Kingdom
› Author Affiliations
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Publication History

Publication Date:
30 December 2019 (online)

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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.

Keywords

bleeding - hemostasis - hemophilia - von Willebrand disease - liver disease - renal failure - thrombocytopenia