OC 14.4 - Perioperative hemostasis management of total joint arthroplasty in patients with Emicizumab.

Background: Real-world experience with hemostatic management in major orthopedic surgeries for emicizumab-treated patients has remained insufficient. In our hospital, patients with emicizumab are administered FVIII concentrates in addition routine emicizumab during Day 0 (surgery day) and Day 14. After Day 14, we manage only with routine emicizumab without additional FVIII except bleeding.

Aims: To evaluate the safety of patients with emicizumab (E group) during the perioperative period of total joint arthroplasties (TJAs) compared to non- emcizumab patients (non-E group).

Methods: A total 16 TJAs were performed in 15 patients with hemophilia A without inhibitor during the period between March 2020 and August 2023 at our hospital. E group (9 patients) and non-E group (7 patients) were evaluated efficacy and safety during the perioperative using Wilcoxon test.

Results: Comparisons of each group was shown in table. Comparison of each group revealed significant difference in years, FVIII doses (pre-operation and Day 15-21). There were no thrombotic event and infection of surgery site in each group, but bleeding was occurred 5 cases in only E group not non-E group during Day 15 to 18 in all cases.

Conclusion(s): In our experience, the hemostatic plan according to guidelines was a safe and effective plan during orthopedic surgery for PwHA without inhibitors on emicizumab prophylaxis. Decrease in absolute dose of emicizumab due to bleeding during surgery may affect bleeding in the last phase of hemostatic control on FVIII decreases.