Management of Persons With Haemophilia Requiring Antithrombotic Therapy: A Canadian Modified Delphi Consensus Study

Area of Science:

• Hematology
• Thrombosis
• Clinical Guidelines

Background:

• Increased life expectancy in persons with haemophilia (PWH) necessitates managing comorbid conditions.
• Antithrombotic therapy (ATT) is increasingly required for PWH to mitigate arterial or venous thrombotic risk.
• Limited evidence currently guides clinical decision-making for ATT in PWH.

Purpose of the Study:

• To establish Canadian consensus recommendations for the management of PWH requiring ATT.
• To provide evidence-based guidance for clinicians caring for PWH on ATT.

Main Methods:

• Modified Delphi technique employed.
• Scoping literature review and focus groups with Canadian haemophilia experts informed initial statements.
• Expert panellists rated statements using a 7-point Likert scale; consensus defined as >70% agreement.

Main Results:

• Eight physicians from five Canadian haemophilia centres participated.
• Consensus was achieved on 32 statements covering general care, risk assessment, treatment planning, and bleeding management.
• All statements reached consensus within two rounds with 100% completion.

Conclusions:

• 32 consensus-based recommendations were developed for managing PWH requiring ATT.
• These recommendations address a critical unmet need in clinical practice.
• The guidelines aim to support complex and evolving clinical decision-making in this patient population.