Optimizing Surgical Approaches for Patients with Inherited Factor VII Deficiency.
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García-Jaén Pablo, Martín de Bustamante José Manuel, Mendoza-Martínez Ana, Galván-Platas Sara, Monleón-Gil Rafael, Calzadilla-Román Karla Susana, Nicolás-Boluda Celia, Rey-Bua Beatriz, Puerta-Vázquez Carlos, Zapata-Tapia Evelyn, Cortés-Rodríguez María, Hortal Ana, Martínez-Robles Violeta, Cebeira-Moro María José, García-Díaz Covadonga, Rodríguez-Alén Agustín, Aguilar-Franco Carlos, Marcellini Shally, Fernández-Fontecha Elena María, Dávila-Valls Julio, Valle-Herrero Sandra, Benito Rocío, Bermejo Nuria, Calvo-Villas José Manuel, Álvarez-Román María Teresa, González-Porras José Ramón, Bastida José María
Аннотация
OBJECTIVES: To describe surgical management and bleeding outcomes in patients with FVIID, and to identify key decision-making variables and predictors of surgical bleeding.
PATIENTS/METHODS: We conducted a multicenter, retrospective study of 380 surgeries performed in 215 patients with FVIID. Patients were classified by FVII:C levels as mild, moderate, or severe deficiency. Bleeding score (BS) was defined according to ISTH-BAT. Surgeries were categorized as low-moderate risk (LR) or high risk (HR) for bleeding. A decision-tree simulation was performed.
RESULTS: Most patients had mild FVIID (76%), and 68% of surgeries were classified as LR. Prophylactic treatment with tranexamic acid (TA) and/or rFVIIa was administered in 42.8% of LR and 62.8% of HR surgeries. Prophylaxis was given to 73.9% of moderate/severe and 41% of mild FVIID patients, especially for HR procedures. FVII:C levels and surgical bleeding risk were key factors that influenced the selection of treatment. The overall bleeding rate was 3.1% (HR: 9%; LR: 0.4%). Most bleeding events occurred in mild FVIID patients with BS ≥3. Our algorithm recommends hemostatic treatment for all moderate/severe, and for mild patients HR surgeries and LR procedures when BS is ≥3.
CONCLUSION: FVII:C levels and surgery type influence prophylactic hemostatic treatment strategies. Patients with mild FVIID, higher BS, and no hemostatic treatment had a greater risk of bleeding. Bleeding score and procedural risk were identified as predictors of surgical bleeding.