Society for Perioperative Assessment and Quality Improvement: a narrative review of best practices for perioperative management of patients with bleeding disorders.

Patients with bleeding disorders comprise a population at elevated risk of adverse events in the perioperative period. Patients might have been previously diagnosed with bleeding disorders or be suspected of having an underlying bleeding disorder. Because of the rarity of these diseases, perioperative management of these patients requires carefully orchestrated multidisciplinary care to prevent adverse outcomes. We present a practical and clinically relevant approach to patients with suspected and known inherited bleeding disorders. For patients with more common bleeding disorders such as von Willebrand disease (vWD), haemophilias, and factor deficiencies, we detail recommendations for perioperative laboratory evaluation and factor and blood product supplementation. We also provide an overview of the diagnosis and perioperative management of less common conditions such as inherited platelet function disorders and disorders of fibrinogen and fibrinolysis. We discuss best practices with regards to availability of specialist expertise and timely phlebotomy, laboratory, and pharmacy resources. A detailed and individualised plan coupled with close communication amongst the perioperative team will help improve care for patients with bleeding disorders undergoing surgery.