People with hemophilia A or B have trouble with blood clotting, which makes surgery risky. Researchers studied 19 patients who had major bone and joint surgeries while using newer clotting medications called rFVIIIFc and rFIXFc. These extended-acting drugs work longer in the body than older versions. The study found that 95% of surgeries went smoothly with good blood clotting control, patients didn’t need blood transfusions, and the medications were safe. This suggests these newer drugs could be a better option for people with hemophilia who need surgery.

The Quick Take

  • What they studied: How well two newer blood-clotting medications work during major bone and joint surgeries in people with hemophilia
  • Who participated: 19 adults (ages 26-60) with hemophilia A or B who had major surgeries like knee replacements, ankle surgery, or hip surgery between 2018 and 2023
  • Key finding: The newer medications controlled bleeding very well in 95% of surgeries (18 out of 20 operations). Patients stayed in the hospital about a week on average and didn’t need blood transfusions. No serious side effects from the medications were seen.
  • What it means for you: If you have hemophilia and need surgery, these newer medications may help your doctors manage bleeding more safely and effectively. However, this is a small study, so more research is needed before making treatment decisions. Talk with your hemophilia specialist about whether these medications are right for you.

The Research Details

Researchers followed 19 people with hemophilia A or B who received major bone and joint surgeries while using two newer clotting medications: rFVIIIFc (for hemophilia A) and rFIXFc (for hemophilia B). These are called “extended half-life” drugs because they stay active in the body longer than older versions, meaning patients don’t need injections as often.

The study tracked what happened during and after 20 surgeries performed between 2018 and 2023. Doctors measured how well the blood clotted, how much medication was needed, how long patients stayed in the hospital, and whether any problems occurred. This type of study is called “prospective,” which means researchers collected information as events happened rather than looking back at old records.

The surgeries included complex procedures like knee and ankle replacements, hip surgery, and removal of old fracture hardware. Most patients had severe hemophilia, meaning their blood clots very poorly without treatment.

This research matters because hemophilia patients face serious bleeding risks during surgery. Older clotting medications require frequent injections and careful timing. The newer extended half-life drugs could make surgery safer and easier to manage. Understanding how well these newer medications work in real surgical situations helps doctors make better treatment plans and helps patients know what to expect.

This study has both strengths and limitations. The strength is that it tracked real patients having actual surgeries, so the results reflect real-world outcomes. The researchers carefully documented bleeding control, medication amounts, and complications. However, the study is small (only 19 patients and 20 surgeries), which means results might not apply to everyone. The study was done at multiple hospitals, which is good. The researchers didn’t compare these newer drugs directly to older medications in this study, so we can’t say definitively that the new drugs are better—just that they appear to work well.

What the Results Show

The main finding was excellent blood clotting control: 95% of surgeries (18 out of 20) had good hemostasis, meaning the blood clotted well enough to prevent dangerous bleeding. Only one surgery had poor clotting control. This is important because it shows the newer medications reliably prevent bleeding problems during major surgery.

Patients needed moderate amounts of medication to stay protected. Those with hemophilia A needed an average of 300 units per kilogram of body weight, while those with hemophilia B needed 388 units per kilogram. These amounts were manageable and allowed doctors to maintain safe clotting levels throughout surgery.

Hospital stays were reasonable, averaging 7 days (ranging from 2 to 18 days). Importantly, no patient needed a blood transfusion, which is significant because transfusions carry their own risks. The average drop in hemoglobin (a protein that carries oxygen in blood) was small at 2.0 grams per deciliter, indicating minimal blood loss during surgery.

No serious side effects from the medications themselves were observed. This is reassuring for patients considering these treatments.

Complications occurred in 45% of cases (9 out of 20 surgeries), but these were manageable. The most common complication was mild anemia (low red blood cell count) in 40% of cases, which doctors treated with iron and folate supplements taken by mouth. One case involved slightly more blood loss than expected. These complications are typical after major surgery and were successfully managed without serious interventions.

Previous research on older clotting medications showed they worked but required more frequent dosing and careful monitoring. This study suggests the newer extended half-life drugs may offer advantages because they stay active longer in the body. However, this study didn’t directly compare the new drugs to older ones, so we can’t say with certainty that they’re better. The excellent safety profile (no medication-related side effects) is consistent with what researchers have seen in other studies of these newer drugs.

This study is relatively small with only 19 patients and 20 surgeries, so results might not apply to everyone with hemophilia. The study didn’t include a comparison group using older medications, so we can’t directly prove the new drugs are better. The study focused on people with severe or moderate hemophilia, so results might differ for those with mild hemophilia. The researchers note that more studies at multiple hospitals are needed to confirm these findings and develop better guidelines for using these medications during surgery.

The Bottom Line

Based on this research, the newer extended half-life clotting medications (rFVIIIFc and rFIXFc) appear to be effective and safe options for people with hemophilia A or B who need major bone and joint surgery. The evidence is moderate quality because the study is small but shows consistent good results. If you have hemophilia and need surgery, discuss these medications with your hemophilia specialist. They can help determine if these drugs are appropriate for your specific situation and medical history.

This research is most relevant for adults with hemophilia A or B who are considering major bone and joint surgeries. It’s particularly important for people who have had joint damage from repeated bleeding (a common hemophilia problem) and need procedures like joint replacement. People with mild hemophilia might have different experiences. This research is less relevant for people with other bleeding disorders or those having minor surgeries. Healthcare providers treating hemophilia patients should be aware of these findings when planning surgical care.

You won’t see benefits overnight. The medications work during and immediately after surgery to prevent dangerous bleeding. Most patients went home after about a week in the hospital. Full recovery from major bone and joint surgery typically takes several weeks to months, depending on the specific procedure. The anemia that developed in some patients improved over weeks with iron and folate supplements. Talk with your surgical team about realistic recovery timelines for your specific procedure.

Want to Apply This Research?

  • If you have hemophilia and are preparing for surgery, track your hemoglobin levels (red blood cell count) before surgery and weekly for 4 weeks after. Also track any symptoms of anemia like fatigue, shortness of breath, or dizziness. Note your medication doses and any bleeding or bruising at the surgical site.
  • Work with your hemophilia care team to understand your specific medication plan before surgery. If prescribed iron or folate supplements after surgery, set daily reminders to take them consistently. Keep a log of how you’re feeling and any concerns to discuss with your doctor at follow-up appointments.
  • Create a post-surgery tracking system that includes: (1) Weekly hemoglobin checks for the first month, (2) Daily notes on energy levels and any unusual bleeding, (3) Medication adherence tracking for supplements, (4) Surgical site healing progress with photos if appropriate. Share this information with your hemophilia team at follow-up visits to ensure proper recovery.

This research describes outcomes in a small group of hemophilia patients undergoing surgery with specific medications. Individual results may vary significantly. This information is educational and should not replace consultation with your hemophilia specialist or surgical team. If you have hemophilia and are considering surgery, work closely with your healthcare providers to develop a personalized treatment plan. Do not make changes to your hemophilia medications or surgical plans based solely on this research. Always discuss new treatment options, including these medications, with your medical team before use.