Brendan Kleiboer1, Marcus A Layer1, Lorraine A Cafuir2, Adam Cuker3, Miguel Escobar4, M Elaine Eyster5, Eric Kraut6, Andrew D Leavitt7, Steven R Lentz8, Doris Quon9, Margaret V Ragni10, Dianne Thornhill11, Michael Wang11, Nigel S Key1, Tyler W Buckner11. 1. Department of Medicine and UNC Blood Research Center, University of North Carolina, Chapel Hill, North Carolina, USA. 2. Emory University School of Medicine, Atlanta, Georgia, USA. 3. Department of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 4. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA. 5. Penn State Hershey Medical Center, Hershey, Pennsylvania, USA. 6. The Ohio State University Hemostasis and Thrombosis Center, Columbus, Ohio, USA. 7. Department of Laboratory Medicine and Department of Internal Medicine, University of California San Francisco, San Francisco, California, USA. 8. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA. 9. Orthopaedic Hemophilia Treatment Center, Orthopaedic Institute for Children, Los Angeles, California, USA. 10. Department of Medicine and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. 11. University of Colorado School of Medicine, Aurora, Colorado, USA.
Abstract
BACKGROUND: Persons with hemophilia (PWH) are at risk for chronic hemophilic arthropathy (HA). Joint replacement surgery may be used to relieve intractable pain and/or restore joint function. OBJECTIVES: This multicenter, prospective, observational cohort study evaluated the rate of bleeding during the postoperative period after total hip (THA) or knee arthroplasty (TKA). PATIENTS/ METHODS: We included PWH of any severity ≥18 years of age who were undergoing THA or TKA. Clinical decisions were made at the discretion of the treating physician according to local standards of care. Clinical data were prospectively recorded. Major bleeding was defined as bleeding in a critical site, bleeding that resulted in either a 2 g/dl or greater decrease in hemoglobin during any 24-h period, or transfusion of two or more units of packed red blood cells. RESULTS: One hundred thirty-one procedures (98 TKA and 33 THA) were performed, 39 (29.8%) of which were complicated by major bleeding, including 46% of THA and 25% of TKA. The risk of major bleeding was increased in THA compared to TKA (OR 2.50, p = .05), and by the presence of an inhibitor (OR 4.29, p = .04), increased BMI (OR 4.49 and 6.09 for overweight and obese, respectively, compared to normal BMI, each p < .01), and non-use of an antifibrinolytic medication (OR 3.00, p = .03). Neither continuous clotting factor infusion (versus bolus infusion) nor pharmacologic thromboprophylaxis were associated with bleeding risk. CONCLUSIONS: The bleeding risk remains substantial after THA and TKA in PWH, despite factor replacement. Use of antifibrinolytic medications is associated with decreased risk.
BACKGROUND: Persons with hemophilia (PWH) are at risk for chronic hemophilic arthropathy (HA). Joint replacement surgery may be used to relieve intractable pain and/or restore joint function. OBJECTIVES: This multicenter, prospective, observational cohort study evaluated the rate of bleeding during the postoperative period after total hip (THA) or knee arthroplasty (TKA). PATIENTS/ METHODS: We included PWH of any severity ≥18 years of age who were undergoing THA or TKA. Clinical decisions were made at the discretion of the treating physician according to local standards of care. Clinical data were prospectively recorded. Major bleeding was defined as bleeding in a critical site, bleeding that resulted in either a 2 g/dl or greater decrease in hemoglobin during any 24-h period, or transfusion of two or more units of packed red blood cells. RESULTS: One hundred thirty-one procedures (98 TKA and 33 THA) were performed, 39 (29.8%) of which were complicated by major bleeding, including 46% of THA and 25% of TKA. The risk of major bleeding was increased in THA compared to TKA (OR 2.50, p = .05), and by the presence of an inhibitor (OR 4.29, p = .04), increased BMI (OR 4.49 and 6.09 for overweight and obese, respectively, compared to normal BMI, each p < .01), and non-use of an antifibrinolytic medication (OR 3.00, p = .03). Neither continuous clotting factor infusion (versus bolus infusion) nor pharmacologic thromboprophylaxis were associated with bleeding risk. CONCLUSIONS: The bleeding risk remains substantial after THA and TKA in PWH, despite factor replacement. Use of antifibrinolytic medications is associated with decreased risk.
Authors: M Escobar; J Maahs; E Hellman; J Donkin; A Forsyth; N Hroma; G Young; L A Valentino; R Tachdjian; D L Cooper; A D Shapiro Journal: Haemophilia Date: 2012-07-09 Impact factor: 4.287
Authors: Michael A Mont; Joshua J Jacobs; Lisa N Boggio; Kevin John Bozic; Craig J Della Valle; Stuart Barry Goodman; Courtland G Lewis; Adolph J Yates; William Charles Watters; Charles M Turkelson; Janet L Wies; Patrick Donnelly; Nilay Patel; Patrick Sluka Journal: J Am Acad Orthop Surg Date: 2011-12 Impact factor: 3.020
Authors: Bhaveen H Kapadia; Matthew R Boylan; Randa K Elmallah; Viktor E Krebs; Carl B Paulino; Michael A Mont Journal: J Arthroplasty Date: 2016-01-21 Impact factor: 4.757
Authors: Desirae E Lindquist; David W Stewart; Aaryn Brewster; Caitlin Waldroup; Brian L Odle; Jessica E Burchette; Hadi El-Bazouni Journal: Clin Appl Thromb Hemost Date: 2018-05-01 Impact factor: 2.389