Variables Affecting Periprocedural Haemostatic Response in Patients With Haemophilia: Real-World Retrospective Study

Patients with haemophilia (PWH) undergoing invasive procedures are at increased risk of periprocedural bleeding, and optimal haemostatic response (HR) depends on patient- and procedure-related factors. We aimed to evaluate variables associated with HR in PWH undergoing invasive procedures.

We performed a retrospective, single-centre study of all invasive procedures in males with haemophilia A or B recorded in a regional reference centre database (2010-2025). Data from electronic records included age, body weight, haemophilia type and severity, inhibitor status, prophylaxis regimen and haemostatic product, pre-procedural haemostatic preparation, genetic mutation (when available) and procedure characteristics. HR was assessed using World Federation of Haemophilia criteria and dichotomised as good/excellent versus fair/poor. Categorical comparisons were performed using Fisher's exact test or Fisher-Freeman-Halton exact tests. Continuous sensitivity analyses were also performed.

Overall, 158 procedures were performed in 61 patients. HR was good/excellent in 151/158 procedures (95.6%) and fair/poor in 7/158 (4.4%). Fair/poor HR occurred in 3/11 procedures (27.3%) in patients weighing >100 kg, compared with 1/87 (1.1%) in those weighing 61-100 kg and 2/51 (3.9%) in those ≤ 60 kg (exact p = 0.003). Major procedures showed a higher proportion of fair/poor HR than minor procedures, although this difference did not reach statistical significance (4/38 [10.5%] vs. 3/120 [2.5%]; Fisher p = 0.058).

High body weight may be associated with suboptimal HR in PWH undergoing invasive procedures, supporting targeted strategies to address overweight and obesity.

The authors have confirmed clinical trial registration is not needed for this submission.