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 |