Incidence of Symptomatic Venous Thromboembolism in Patients with Hemophilia Undergoing Hip and Knee Joint Replacement without Chemoprophylaxis: A Retrospective Study

Abstract

Objective To establish the prevalence of clinically significant venous thromboembolic events (VTE) in hemophilia patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) without chemoprophylaxis and a modified coagulation factor substitution. Methods A cohort of patients who underwent THA and TKA from June 2002 to April 2017 were included. Based on World Federation of Hemophilia (WFH) guidelines, a modified coagulation factor substitution regimen was adopted. All patients were under a standardized postoperative protocol with routine mechanical prophylaxis against VTE. None of the patients received prophylactic anticoagulation. Only symptomatic patients were referred for radiological examination to exclude VTE. We evaluated the patient demographics and calculated the prevalence of VTE in our cohort. Results A total of 98 patients were reviewed. The patients were all men. Thirty‐one patients underwent primary THA with 39 hip arthroplasties (only 1 case with hemophilia B) and 67 patients underwent primary TKA with 101 knee arthroplasties (5 cases with hemophilia B). The mean age was 34.2 ± 7.8 years. The mean body mass index was 21.2 ± 5.7 kg/m2. There was 100% compliance to mechanical prophylaxis. The mean time to ambulation was 6.8 days (±2.5 days), and the mean hospital stay was 32.4 days (±7.1 days). There was only 1 hemophilia B patient with clinically significant VTE. None of the other 97 surgical cases had symptomatic VTE within 6 months after the procedure. This translates to a prevalence of 1.02%. Conclusion Given the low incidence (1.02%) of clinically significant VTE in our cohort, routine chemoprophylaxis in hemophilia patients undergoing THA and TKA may not be needed.

In-Hospital Complications and Readmission in Patients with Hemophilia Undergoing Hip or Knee Arthroplasty

“…The true incidence of symptomatic venous thromboembolism (VTE) in patients with hemophilia undergoing such surgeries is still uncertain. The estimated incidence in previous retrospective studies ranged from 0% to 1% 10 - 12 , whereas the incidence of symptomatic VTE was as high as 4.3% in 1 prospective multicenter study 13 . In our study, the incidence of VTE was comparable between the hemophilia and control cohorts for both hip (0% versus 0.64%) and knee (1.15% versus 0.98%) procedures.…”

Total knee arthroplasty in hemophilia A

“…The incidence of major bleeding in patients with hemophilia undergoing total hip arthroplasty or total knee arthroplasty in the setting of low-weight molecular heparin use is estimated to be 50% [32]. Moreover, the overall incidence of major bleeding for patients with hemophilia undergoing total joint arthroplasty regardless of prophylaxis type is estimated to be 39.1% [32]. The authors' institution as well as previous reports recommend the use of nonpharmacologic DVT prophylaxis such as IPCDs and early ambulation [10].…”

“…Although the use of DVT prophylaxis is of standard protocol in most patients undergoing total joint arthroplasty, the hemophilia population represents a unique cohort in which the risk of bleeding with pharmacologic DVT prophylaxis must be weighed with the risk of venous thromboembolism. The incidence of major bleeding in patients with hemophilia undergoing total hip arthroplasty or total knee arthroplasty in the setting of low-weight molecular heparin use is estimated to be 50% [32]. Moreover, the overall incidence of major bleeding for patients with hemophilia undergoing total joint arthroplasty regardless of prophylaxis type is estimated to be 39.1% [32].…”

Risk of deep venous thrombosis after total knee arthroplasty in patients with haemophilia A

“…In subsequent study, DVT was not detected by US after TKA in 36 Japanese patients with haemophilia 9 . Retrospective studies from China and the United States have reported that the prevalence of clinically significant VTE among haemophilic patients who underwent TKA and THA without routine chemoprophylaxis was in the range of 0%‐1.4% 15‐17 . These very low rates may underestimate small thrombus formation, because the studies evaluated symptomatic VTE from medical records, not from evaluation of fixed methods 15‐17 .…”