Skip to main content

Table 1 Perioperative management for cardiac surgery in patients with acquired hemophilia A [4, 5]

From: Aortic root repair in a patient with acquired hemophilia A: case report

Preoperative Check baseline FVIII and FVIII inhibitor levels
Check baseline standard clotting tests
Establish two reliable venous access points—one for sampling and the other for administration of FVIII
Infuse a trial of porcine rFVIII and evaluate therapeutic response for dose adjustment
Give bolus of the calculated porcine rFVIII to achieve target FVIII level of 100 IU/dL (administered 2–3 h before surgery)
Intra-operative Check FVIII level prior to first incision (target > 100 IU/dL)
Repeat FVIII level checks before heparinization—give bolus of rFVIII if level is < 100 IU/dL
Repeat FVIII level checks every 30 min during CPB—patient will need chromogenic FVIII/heparin neutralization in laboratory
Check FVIII level immediately after CPB and after protamine infusion—give bolus if level is < 100 IU/dL)
Postoperative Repeat FVIII level checks at 4- to 6-h intervals during early postoperative period
Check FVIII levels 2 times/day during the first 3 postoperative days and less frequently thereafter
Give bolus of rFVIII if required
  1. CPB cardiopulmonary bypass, FVIII Factor VIII, rFVIII recombinant Factor VIII