Surgery In Patients With Factor Viii Inhibitors: A Retrospective Case Series At The Largest Canadian Hemophilia Care Centre

Introduction: Factor VIII (FVIII) inhibitors develop in a significant proportion of patients with severe congenital hemophilia A (CHA) and is also rarely acquired (AHA). These patients are at high risk of bleeding, particularly with surgical challenge. FVIII bypassing therapy and porcine factor VIII products have decreased the risk of bleeding complications and provided the opportunity for elective surgical intervention in this patient population. Factor VIII bypassing agents include activated Prothrombin Complex Concentrate (aPCC or FEIBA) and activated recombinant Factor VII (rFVIIa, Niastase). Porcine factor VIII products include plasma-derived Hyate C (historically) and currently, recombinant Obizur. To our knowledge, this is the largest Canadian review of perioperative management and outcomes in patients with factor VIII inhibitors.