Aspects of hemostasis controllability in patients with inhibitory hemophilia during surgery

Shutov S.A.

National Research Center for Hematology

SPIN RSCI: 8698-8529
Scopus AuthorID: 16239780800
ORCID: 0000-0002-5347-2947

Danishyan K.I.

National Medical Research Center for Hematology

Prasolov N.V.

National Research Center for Hematology

Zozulya N.I.

National Research Center for Hematology

SPIN RSCI: 4480-5590
Scopus AuthorID: 57219322107
ResearcherID: N-3151-2014
ORCID: 0000-0001-7074-0926

Polyanskaya T.Yu.

National Research Center for Hematology

SPIN RSCI: 2780-8122
Scopus AuthorID: 8891152300
ResearcherID: AAH-6410-2021
ORCID: 0000-0002-4143-3094

Kitsenko E.A.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0002-8268-3129

Aspects of hemostasis controllability in patients with inhibitory hemophilia during surgery

Authors:

Shutov S.A., Danishyan K.I., Prasolov N.V., Zozulya N.I., Polyanskaya T.Yu., Kitsenko E.A.

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Journal: Endoscopic Surgery. 2022;28(6): 45‑52

DOI: 10.17116/endoskop20222806145

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To cite this article:

Shutov SA, Danishyan KI, Prasolov NV, Zozulya NI, Polyanskaya TYu, Kitsenko EA. Aspects of hemostasis controllability in patients with inhibitory hemophilia during surgery. Endoscopic Surgery. 2022;28(6):45‑52. (In Russ.)
https://doi.org/10.17116/endoskop20222806145

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BACKGROUND

The presence of blood coagulation factors inhibitors complicates the course of the disease in 15—32% of patients with hemophilia. Any surgical intervention in these patients is associated with a high risk of severe hemorrhagic complications both during surgery and in postoperative period, which requires reliable hemostasis and clear laboratory monitoring of the effectiveness of hemostatic therapy.

OBJECTIVE

The purpose of the presented observation is to identify the problems of ensuring hemostasis during surgical interventions in patients with an inhibitory form of hemophilia.

MATERIAL AND METHODS

The analysis of 5 surgical interventions in patients with inhibitory form of hemophilia was carried out. The operations were performed at the National Medical Research Center for Hematology in the period 2016—2020. The median age is 46 years. All interventions were performed on the abdominal organs: 4 operations using laparoscopic access (1 cholecystectomy, 2 hernioplasty, 1 ureterolithotomy) and 1 hernioplasty. Hemostatic therapy was carried out by AICC and rFVIIa.

RESULTS

Complications in the postoperative period were recorded in 4 cases — in three patients — hemorrhagic complications, in 1 patient — thrombotic. Hemorrhagic complications were observed on the first day after surgery and required correction of hemostatic therapy. The decisive factor in the critical thrombosis of the splenic artery of one of the patients was an increase in the blood coagulation potential with the introduction of rFVIIa against the background of depletion of the fibrinolytic system (prolongation of XIIa-dependent fibrinolysis from 25 to 75 minutes) and a decrease in the concentration of antithrombin III involved in FVIIa inactivation, up to 81%.

CONCLUSION

The use of standard hemostatic therapy protocols does not provide reliable and safe hemostasis in the inhibitory form of hemophilia. When prescribing hemostatic therapy for patients with hemophilia, it is necessary to take into account individual characteristics of each patient: compensatory mechanisms of the coagulation system, comorbid pathology, changes in the clinical situation. For personalized selection of a hemostatic therapy regimen and control of the hemostatic system under real physiological conditions, it is necessary to evaluate the results of all possible hemostasiological tests, both routine and integral, before surgery and during perioperative period to reduce the risk of hemorrhagic and thrombotic complications.

Keywords:

inhibitory form of hemophilia

hemorrhagic complications

acute arterial thrombosis

splenic infarction

thromboelastography

Authors:

Shutov S.A.

National Research Center for Hematology

SPIN RSCI: 8698-8529
Scopus AuthorID: 16239780800
ORCID: 0000-0002-5347-2947

Danishyan K.I.

National Medical Research Center for Hematology

Prasolov N.V.

National Research Center for Hematology

Zozulya N.I.

National Research Center for Hematology

SPIN RSCI: 4480-5590
Scopus AuthorID: 57219322107
ResearcherID: N-3151-2014
ORCID: 0000-0001-7074-0926

Polyanskaya T.Yu.

National Research Center for Hematology

SPIN RSCI: 2780-8122
Scopus AuthorID: 8891152300
ResearcherID: AAH-6410-2021
ORCID: 0000-0002-4143-3094

Kitsenko E.A.

Petrovsky National Research Centre of Surgery

ORCID: 0000-0002-8268-3129

Received:

18.03.2022

Accepted:

03.08.2022

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