Abstract

A standard replacement treatment by FVIII or FIX concentrates is in most cases ineffective in haemophilic patients with inhibitors. To overcome this problem, the so-called bypassing agents (BPAs) have been introduced in the market and patients may be efficaciously treated also in the orthopaedic setting. However not all patients with inhibitors need to be treated at the same manner. In a proportion of patients a standard replacement therapy by FVIII and FIX concentrates may be useful for the postoperative period or just for a part of it. Ancillary therapy by tranexamic acid may significantly contribute to the bleeding control while anti-thrombotic drugs seem unnecessary differently from non haemophilic patients. Brand new drugs are now being studied representing a potential actual revolution in the treatment of patients with haemophilia and inhibitors.