Neuraxial Anesthesia in Severe Hemophilia A Using Extended Half-Life Factor VIII (Efanesoctocog Alfa): A Case Report

Hemophilia A presents significant perioperative challenges, particularly for neuraxial anesthesia due to the risk of spinal or epidural hematoma. Extended half-life recombinant factor VIII products (EHL), such as efanesoctocog alfa, provide sustained FVIII activity. We report a 52-year-old man with severe hemophilia A on weekly EHL prophylaxis undergoing total knee arthroplasty under spinal anesthesia with an adductor canal block. FVIII levels were maintained with a combination of EHL and standard factor VIII replacement. The patient had no neurologic sequelae. Safe neuraxial anesthesia can be achieved in hemophilia A with a combination of EHL and standard factor VIII replacement.