Hemostatic Considerations of New Treatment Options for Hemophilia During Surgery, Infection, and Bleeding in Children and Adolescents.

In recent years, the therapeutic landscape for hemophilia has changed significantly, with the approval of several innovative agents, some featuring entirely novel mechanisms of action. These advances have substantially improved outcomes and reduced the treatment burden. However, clinical experience with these novel therapies in special situations-such as bleeding, surgery, trauma, and infection-remains limited. Factor replacement therapy has been the standard of care for a long time, with extensive clinical experience. The introduction of non-factor therapies has raised important questions: Is additional treatment required after injury or during surgery? What are the considerations in cases of sepsis or disseminated intravascular coagulation (DIC)? This summary focuses on emicizumab, efanesoctocog alfa, newly approved TFPI inhibitors, nonacog beta pegol, and the extension of indications for PEGylated FVIII preparations to younger age groups. We will therefore also briefly address these developments. The largest part of this manuscript will focus on emicizumab due to its longer approval history and the most extensive data available. Most other medications were licensed in 2024 or later.