Juliana Perez Botero1, Daniel B Spoon2, Mrinal S Patnaik1, Aneel A Ashrani1, Robert T Trousdale3, Rajiv K Pruthi4. 1. Division of Hematology, Mayo Clinic, Rochester, Minnesota, United States. 2. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States. 3. Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, United States. 4. Division of Hematology, Mayo Clinic, Rochester, Minnesota, United States. Electronic address: pruthi.rajiv@mayo.edu.
Abstract
INTRODUCTION: Venous thromboembolism (VTE) is a recognized complication after joint replacement surgery, and prophylaxis is routinely used in patients without bleeding disorders. However, for patients with hemophilia, pharmacologic prophylaxis is highly variable and controversial because of the inherent bleeding risk. AIM: To review our institutional experience with outcomes of total knee or hip arthroplasty with regard to symptomatic VTE and use of VTE prophylaxis in patients with hemophilia and without inhibitors. METHODS: We reviewed records of 42 consecutive patients with hemophilia A or B who underwent 71 hip or knee replacements over a 39-year period. We also reviewed the literature to estimate the incidence of VTE after arthroplasty in the hemophilia population. RESULTS: All patients used compression stockings for up to 6weeks after surgery; additionally, 6 cases (10.5%; 57 with available data) used sequential intermittent compression devices and 2 (2.8%) postoperatively received low-molecular-weight heparin. One patient (1.4%) who received low-molecular-weight heparin had a symptomatic, lower-extremity, deep venous thrombosis 10days after hip replacement for traumatic fracture. None of the other 70 surgical cases had symptomatic VTE within 3months after the procedure. Analysis of pooled data from published series of hemophilia patients undergoing arthroplasty showed an estimated incidence of symptomatic VTE of 0.5%. CONCLUSION: Our study suggests that in patients with hemophilia, joint replacement surgery can be performed safely without routine pharmacologic VTE prophylaxis and without increasing risk of thromboembolic events. Pharmacologic VTE prophylaxis may be considered in select patients with known additional risk factors for VTE.
INTRODUCTION:Venous thromboembolism (VTE) is a recognized complication after joint replacement surgery, and prophylaxis is routinely used in patients without bleeding disorders. However, for patients with hemophilia, pharmacologic prophylaxis is highly variable and controversial because of the inherent bleeding risk. AIM: To review our institutional experience with outcomes of total knee or hip arthroplasty with regard to symptomatic VTE and use of VTE prophylaxis in patients with hemophilia and without inhibitors. METHODS: We reviewed records of 42 consecutive patients with hemophilia A or B who underwent 71 hip or knee replacements over a 39-year period. We also reviewed the literature to estimate the incidence of VTE after arthroplasty in the hemophilia population. RESULTS: All patients used compression stockings for up to 6weeks after surgery; additionally, 6 cases (10.5%; 57 with available data) used sequential intermittent compression devices and 2 (2.8%) postoperatively received low-molecular-weight heparin. One patient (1.4%) who received low-molecular-weight heparin had a symptomatic, lower-extremity, deep venous thrombosis 10days after hip replacement for traumatic fracture. None of the other 70 surgical cases had symptomatic VTE within 3months after the procedure. Analysis of pooled data from published series of hemophiliapatients undergoing arthroplasty showed an estimated incidence of symptomatic VTE of 0.5%. CONCLUSION: Our study suggests that in patients with hemophilia, joint replacement surgery can be performed safely without routine pharmacologic VTE prophylaxis and without increasing risk of thromboembolic events. Pharmacologic VTE prophylaxis may be considered in select patients with known additional risk factors for VTE.
Authors: Kylee L Martens; Simone E Dekker; Megan Crowe; Thomas G DeLoughery; Joseph J Shatzel Journal: Thromb Res Date: 2022-08-19 Impact factor: 10.407
Authors: Stephen M Gillinov; Patrick J Burroughs; Harold G Moore; Lee E Rubin; David B Frumberg; Jonathan N Grauer Journal: J Arthroplasty Date: 2022-03-04 Impact factor: 4.435
Authors: Andrzej Kotela; Magdalena Wilk-Frańczuk; Piotr Żbikowski; Paweł Łęgosz; Paweł Ambroziak; Ireneusz Kotela Journal: Med Sci Monit Date: 2017-01-09