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How to manage bleeding disorders in aging patients needing surgery
Mouhamed Yazan Abou-Ismail1, Nathan T Connell2,3
1Division of Hematology and Hematologic Malignancies, Department of Internal Medicine, University of Utah, Salt Lake City, UT.
Hematology. American Society of Hematology. Education Program
|December 10, 2021
Summary
Aging patients with bleeding disorders require specialized perioperative care due to increased risks of thrombosis and bleeding. Optimal management necessitates a multidisciplinary approach, as evidence-based guidelines are limited.
Area of Science:
- Hematology
- Geriatrics
- Perioperative Medicine
Background:
- Improved medical care increases life expectancy for patients with bleeding disorders, leading to a growing elderly population.
- Older adults with bleeding disorders face age-related comorbidities and require procedures, complicating management.
- Current evidence-based guidelines for managing aging patients with bleeding disorders are scarce due to underrepresentation in trials and rarity of conditions.
Observation:
- Older adults with bleeding disorders present unique challenges, including increased risks of thrombosis and volume overload.
- Antithrombotic therapy, often necessary for cardiovascular interventions, demands a meticulous, individualized approach in this population.
- Perioperative hemostatic management is complex, requiring careful consideration of bleeding risks and comorbidities.
Findings:
- Current guidelines for perioperative hemostatic management in older adults with hemophilia, von Willebrand disease, and rare bleeding disorders are discussed.
- The management of these patients is complex and requires a thorough multidisciplinary approach.
- Optimal care involves collaboration between hematologists, surgeons, anesthesiologists, and other specialists.
Implications:
- There is a critical need for developing evidence-based guidelines for the perioperative management of aging patients with bleeding disorders.
- A multidisciplinary and individualized approach is essential for ensuring the safety and optimal outcomes for older adults with bleeding disorders undergoing procedures.
- Further research is needed to address the underrepresentation of older adults in clinical trials for bleeding disorders.
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