Title:‘Do not Do’ Recommendations in Hemophilia
Volume: 20
Issue: 3
Author(s): Hortensia De la Corte-Rodriguez, E. Carlos Rodriguez-Merchan*, M. Teresa Alvarez-Roman, Monica Martin-Salces and Victor Jimenez-Yuste
Affiliation:
- Department of Orthopedic Surgery, La Paz University Hospital-IdiPaz, Madrid,Spain
Keywords:
Hemophilia, do not do, recommendations, patient safety, health resources, clinical guidelines.
Abstract:
Background: It is important to discard those practices that do not add value. As a result,
several initiatives have emerged. All of them try to improve patient safety and the use of health
resources.
Purpose: To present a compendium of "do not do recommendations" in the context of hemophilia.
Methods: A review of the literature and current clinical guidelines has been made, based on the best
evidence available to date.
Results: The following 13 recommendations stand out: 1) Do not delay the administration of factor
after trauma; 2) do not use fresh frozen plasma or cryoprecipitate; 3) do not use desmopressin in
case of hematuria; 4) do not change the product in the first 50 prophylaxis exposures; 5) do not
interrupt immunotolerance; 6) do not administer aspirin or NSAIDs; 7) do not administer intramuscular
injections; 8) do not do routine radiographs of the joint in case of acute hemarthrosis; 9) Do
not apply closed casts for fractures; 10) do not discourage the performance of physical activities;
11) do not deny surgery to a patient with an inhibitor; 12) do not perform instrumental deliveries in
fetuses with hemophilia; 13) do not use factor IX (FIX) in patients with hemophilia B with inhibitor
and a history of anaphylaxis after administration of FIX.
Conclusion: The information mentioned previously can be useful in the management of hemophilia,
from different levels of care. As far as we know, this is the first initiative of this type regarding
hemophilia.
