Question

How will you manage and monitor the post-operative care in this patient?

Hint:

After surgery, continue with bypassing agents and closely monitor coagulation parameters. Adjust the treatment based on the patient’s clinical status.

Answer 1

Step 1: Postoperative Bleeding Risk.
In hemophilia A patients with inhibitors, the risk of bleeding remains elevated postoperatively. Therefore, the management involves preventing and controlling bleeding, while also avoiding complications from treatment.

Step 2: Treatment Options for Postoperative Care.
1. Bypassing agents: Continue administering rFVIIa or aPCC in the immediate postoperative period to maintain hemostasis. The dosage and frequency of administration should be adjusted based on the bleeding risk and clinical condition.
2. Monitoring coagulation parameters: Monitor the patient closely for any signs of bleeding, including bleeding from surgical sites, internal bleeding, or excessive bruising. Regular laboratory tests, including aPTT and fibrinogen levels, should be used to guide treatment.
3. Close monitoring in a controlled environment: Postoperative care should be provided in a setting that allows for continuous monitoring and prompt management of any bleeding or clotting complications.