Managing Preoperative Hemostasis in Patients with Inherited and Acquired Bleeding Disorders

Inherited and acquired bleeding disorders pose significant hemostatic challenges for surgery. Patients at particular risk of bleeding include those with inherited bleeding disorders such as hemophilia, von Willebrand disease, and platelet function defects; those on antiplatelet agents or anticoagulants; and those with acquired conditions such as immune thrombocytopenic purpura, liver disease, or renal impairment. Each has its own specific challenges and close collaboration between the anesthetic, surgical, and hematology teams is crucial. Optimizing surgical hemostasis for patients at risk involves attention to detail, with careful preoperative planning, meticulous surgical technique, prompt identification of complications and judicious use of hemostatic agents and blood components. This article gives an overview of the bleeding risks involved and therapeutic options to overcome them.