Researchers discovered that minor surgeries can be safely performed in patients with hemophilia A receiving emicizumab prophyalxis, with or without factor VIII (FVIII) inhibitors, as published in Haemophilia.

Since patients with hemophilia A are at a greater risk of prolonged bleeding, the management of surgery is an important aspect of hemophilia care. However, minor surgical operations, such as endoscopies and dental surgeries, are relatively common.

Emicizumab prophylaxis has been shown to effectively control bleeding in patients with hemophilia with or without inhibitors. Multiple studies have confirmed this; however, these studies do not look into the specific use of emicizumab in patients with hemophilia A undergoing surgery. This is reflected in the fact that guidelines do not exist on patients with hemophilia A undergoing surgery while on emicizumab prophylaxis.

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Escobar and colleagues presented a phase 4 study on patients with hemophilia A who are on emicizumab and scheduled to undergo a minor surgical procedure within 60 days of enrollment. The participants intended to continue receiving emicizumab for 1 month or more following surgery.

Three endpoints were measured: the percentage of patients who experience excessive bleeding, the percentage of patients who did not have excessive bleeding, and the occurrence of bleeding postsurgery.

A total of 14 patients were enrolled for this study. Overall, the majority of participants with or without FVIII inhibitors did not have excessive bleeding at the surgical site. One patient experienced excessive bleeding during surgery and 4 experienced postoperative bleeding. These findings were consistent with previously published studies and real-world data from patients on emicizumab undergoing minor surgery.

“Common minor surgeries, such as [central venous access devices] removals and simple dental extractions, can be safely performed in [patients with hemophilia A] with or without FVIII inhibitors receiving emicizumab prophylaxis.,” the authors concluded.


Escobar M, Dunn A, Quon D, et al. A phase IV, multicentre, open-label study of emicizumab prophylaxis in people with haemophilia A with or without FVIII inhibitors undergoing minor surgical proceduresHaemophilia. Published online May 5, 2022. doi:10.1111/hae.14574