This risk may be particularly increased in older patients and in the setting of overcorrected FVIII levels AUY-922 supplier [49, 50]. Whereas postoperative anticoagulation (e.g. low-molecular-weight heparin) has been advocated in specific groups of patients with haemophilia without inhibitors,

namely older patients who have undergone major orthopaedic surgery [49] and patients with normal or near-normal trough factor levels following factor replacement [50], this practice is not generally recommended in patients with inhibitors [49, 50]. Instead, non-pharmacological measures, such as intermittent pneumatic or graded compression methods, may be used [49]; however, pharmacological thromboprophylaxis may be considered in patients with underlying thrombophilia [46]. Infection may be especially catastrophic after joint replacement, potentially prompting prosthetic removal. Patients with haemophilia are at increased risk for delayed infection in particular [14]. The most likely source of delayed infection in this population is bacteraemia Dabrafenib clinical trial from a CVAD or during a dental procedure. Therefore, patients with CVADs or joint hardware should receive antimicrobial prophylaxis before any dental procedure. In addition, patients or their carers should be educated regarding the importance of using strict aseptic technique when caring for and accessing CVADs or PICCs or when attempting

self-infusion. Bleeding is perhaps the most serious concern after surgery in CHwI. Bleeding Protein kinase N1 into the operative site after arthroplasty may lead to infection and loss of the prosthesis [51]. Therefore, in contrast to the traditional postsurgical approach, early mobilization of patients

with inhibitors after arthroplasty is often discouraged because of the possibility of bleeding, even at the risk of compromising ultimate range of motion [51]. Once physical therapy is instituted, pretreatment with a bypassing agent is recommended before each therapy session for 2–4 weeks after surgery [52, 53]. For most major surgeries reported in the literature, haemostatic therapy was continued for ca 10–14 days, with longer durations in cases complicated by postoperative bleeding. When unexpected postoperative bleeding occurs, several strategies may apply, including adjustment of dosing or replacement of the current haemostatic agent, cessation of rehabilitative measures, or platelet transfusion if there is thrombocytopenia or evidence of platelet dysfunction [13]. Consultation with the haematology team in the event of excessive postoperative bleeding is critical. Discharge planning for home, rehabilitative, or other facilities should be an integral part of preoperative assessment and should include an evaluation of the home environment and psychosocial support system by the HTC.