Local fibrin glue and chitosan-based dressings in haemophilia surgery.

Fibrin glue and chitosan-based dressings (CBDs) could be useful local haemostatic agents for severe haemorrhage in persons with haemophilia undergoing surgical procedures. The aim of the present study was to clarify the role of fibrin glue and CBDs in persons with haemophilia. A review of the most recent literature on the topic was performed. Local fibrin glue and CBDs are not always necessary to achieve haemostasis in all surgical procedures performed in persons with haemophilia. However, they could be good adjunct therapies, mainly when a surgical field or a surgical wound potentially will bleed more than expected (i.e. patients with inhibitors), and also circumcisions, dental extractions, and some orthopaedic procedures (mainly the surgical removal of pseudotumours). Although a correct surgical haemostasis can be usually achieved by the infusion of factor concentrate at the right dose, my recommendation for surgeons is always to have fibrin glue and CBDs by their side. CBDs could be better haemostatic dressings for control of haemorrhage than current standards of care. To clarify the real value of fibrin glue and CBDs in surgery of haemophilia in specific situations new well designed prospective comparative studies should be carried out.