Diagnosis and therapy of coagulation disorders in operative orthopedics.

Patients suffering from von-Willebrand-disease or hemophilia A or B are the most common patients with coagulation disorders in orthopedic hospitals. Patients suffering from hemophilia A or B are treated with pure factor VIII or IX concentrates. We prefer recombinant products. The goals are normal levels of F VIII or F IX activity during the operation and postoperatively. In order to save costs the continuous infusion is recommended. Approximately 30 % of products and costs my be saved. The prevalence of von-Willebrand-disease is very high in Europe and USA (1 %). Typical presentation of these patients is the uncontrollable bleeding during an operation; typical is also the bleeding from mucous membranes. Patients with mild disorders are treated with DDAVP. Patients suffering from type 3 need substitution therapy with von-Willebrand-factor containing concentrates (for example Humate P).