Management of Persons With Haemophilia Requiring Antithrombotic Therapy: A Canadian Modified Delphi Consensus Study

Introduction

Advancements in haemophilia care have extended the life expectancy of persons with haemophilia (PWH), giving rise to new clinical challenges including the need for antithrombotic therapy (ATT) in mitigating arterial or venous thrombotic risk. However, evidence to support clinical decision-making in this context remains limited, despite its growing importance.

Aims

To develop Canadian consensus recommendations for managing PWH requiring ATT.

Methods

A modified Delphi technique was used. Initial statements were generated using information from a scoping literature review and focus groups with Canadian haemophilia experts. Key areas included risk assessment, tailored treatment planning, ATT selection and management of breakthrough bleeding. Expert panellists were recruited through the Association of Haemophilia Clinic Directors of Canada using convenience sampling. Participants independently reviewed and rated each statement using a 7-point agreement-based Likert scale, with consensus defined a priori as over 70% agreement among panellists. Statements that did not reach consensus in the first round were modified based on participants’ comments.

Results

Eight physicians (median experience in PWH care: 11.0 years) from five haemophilia treatment centres across four Canadian provinces participated. All panellists had experience managing thromboembolic complications and using ATTs in PWH. Consensus was attained for 32 statements on general aspects of care, risk assessment, treatment planning and management of bleeding complications. All statements attained consensus after two rounds with a 100% completion rate.

Conclusion

This Canadian study yielded 32 consensus-based recommendations for managing PWH requiring ATT, addressing an unmet need to guide clinical decision-making in this complex and evolving area.