JTH in the Clinic: Deconstructing the ISTH Hemophilia Guidelines for the Clinician.

Recently, the ISTH Hemophilia Guidelines were published in this journal. The authors of these guidelines should be commended for a Herculean task that took years to complete, and while this is no doubt a welcome addition to the literature, it does leave many questions for the clinician. Primarily this is due to as 11 of the 13 recommendations being conditional essentially meaning "that clinicians and patients need to consider individual preferences as well as the specific circumstances in which the decision is being made for implementation of the recommendation." So, in essence, most of the recommendations leave it up to the clinician to decide whether to use them or not. In our view, most clinicians are seeking more concrete recommendations when they seek out a guidelines paper. Unfortunately, hemophilia being a rare disease and the ISTH Guidelines relying upon the GRADE methodology resulted in so many conditional recommendations. We endeavored to "deconstruct" the ISTH recommendations and offer clinicians a more concrete path forward based in part on the guidelines but supplemented with more recent literature and our own extensive experience and perspective managing hemophilia patients of all ages from 4 continents.