Managing Breakthrough Bleeding in Hemophilia: Strategies and Considerations

Breakthrough bleeding in hemophilia requires prompt and targeted intervention to minimize complications. Traditional treatment relies on on-demand factor replacement therapy, which replenishes the deficient clotting factor and rapidly controls bleeding. Adjunctive measures, such as antifibrinolytic agents, may also be used to support hemostasis. For patients receiving newer non-factor therapies, including mimetics or rebalancing agents, management of breakthrough bleeds may differ, often requiring supplemental factor therapy or adjustments in dosing to achieve hemostatic control. The type of prophylaxis in use directly informs management decisions; clinicians must consider the patient’s baseline therapy, timing of the last dose, and expected pharmacokinetics when determining the optimal intervention. Individualized plans and patient education on early recognition and rapid response are critical to preventing joint damage and preserving quality of life.