Peri-Surgical Considerations

• Special planning is required before, during, and after surgery
• Post-surgery complications are not uncommon

  –	Should be managed on the basis of underlying etiology

• Dosage and duration of clotting factor concentrate depend on the type of surgery being performed

  –	Varying according to the individual case
  –	Adequate levels can promote healing as well as prevent bleeding
  –	Bolus dosing creates more peaks/troughs, while continuous infusion (CI) creates a more steady state of plasma factor levels

• Target trough levels:

  –	Recommended 80% to 100% immediately after surgery

Bona RD, et al. Am J Hematol. 1989;32:8-13.

Michelle Witkop, DNP, FNP-BC Doctor of Nursing Practice Bleeding Disorders Nurse Practitioner Northern Regional Bleeding Disorders Center Munson Medical Center