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.
