Targeting Factor IX levels in patients with. Haemophilia B who are undergoing surgery is ‘complex and suboptimal’ but the incidence of bleeding complications is low – so say specialists from the UK and the Netherlands (Haemophilia 2018;April 29. DOI: 10.1111/hae.13469).

The study assessed outcomes in 255 minor and major surgical carried out between 2000 and 2015 procedures in 118 patients (median age 40). Factor IX levels were <0.05 IU/ml-1. Within the first 24 hours after surgery, 60% of FIX levels were below the target of 0.80 – 1.00 IU/ml-1 by a median of 0.22 IU/ml-1. At 6 days, when the target range was 0.30 – 0.50 IU/ml-1, this figure had fallen to 9%, with 59% of levels above the target range by a median of 0.19 IU/ml-1. Clinically relevant bleeding complications – defined as requiring a second surgical intervention or red cell transfusion – affected 7 procedures (2.7%).

The authors question the value of perioperative FIX levels recommended by management guidelines when the risk of bleeding complications is low even when targets are not met.

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