Postoperative bleeding complications in patients with hemophilia undergoing major orthopedic surgery: A prospective multicenter observational study

Kleiboer, Brendan; Layer, Marcus A.; Cafuir, Lorraine; Cuker, Adam; Escobar, Miguel A.; Eyster, M. Elaine; Kraut, Eric H.; Leavitt, Andrew D.; Lentz, Steven R.; Quon, Doris; Ragni, Margaret V.; Thornhill, Dianne; Wang, Michael; Key, Nigel S.; Buckner, Tyler W.

doi:10.1111/jth.15654

Cited by 23 publications

(17 citation statements)

References 37 publications

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“…In 2022, Kleiboer et al analyzed 98 TKAs in PWH of which 25% were complicated by major bleeding [ 28 ]. The risk of major bleeding was augmented by the presence of an inhibitor, increased body mass index (BMI), and non-use of an antifibrinolytic medication.…”

Section: Resultsmentioning

confidence: 99%

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Complications and Implant Survival of Total Knee Arthroplasty in People with Hemophilia

Rodríguez-Merchán

Corte‐Rodríguez²,

Álvarez-Roman³

et al. 2022

JCM

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Total knee arthroplasty (TKA) is a commonly used option in advanced stages of knee arthropathy in people with hemophilia (PWH). The objective of this article is to determine what the complication rates and implant survival rates in PWH are in the literature. A literature search was carried out in PubMed (MEDLINE), Cochrane Library, Web of Science, Embase and Google Scholar utilizing the keywords “hemophilia TKA complications” on 20 October 2022. It was found that the rate of complications after TKA in PWH is high (range 7% to 30%), although it has improved during the last two decades, possibly due to better perioperative hematologic treatment. However, prosthetic survival at 10 years has not changed substantially, being in the last 30 years approximately 80% to 90% taking as endpoint the revision for any reason. Survival at 20 years taking as endpoint the revision for any reason is 60%. It is possible that with a precise perioperative control of hemostasis in PWH, the percentage of complications after TKA can be diminished.

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Section: Resultsmentioning

confidence: 99%

“…Neither continuous clotting factor infusion (versus bolus infusion) nor pharmacologic thromboprophylaxis were associated with bleeding risk. Use of antifibrinolytic medications was associated with diminished risk [ 28 ].…”

Section: Resultsmentioning

confidence: 99%

Complications and Implant Survival of Total Knee Arthroplasty in People with Hemophilia

Rodríguez-Merchán

Corte‐Rodríguez²,

Álvarez-Roman³

et al. 2022

JCM

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“…In the recent literature, for major operations such as knee arthropathy surgery, it has been proved that only replacement therapy can not reduce the risk of postoperative bleeding, and stronger medical assistance is needed [25]. This may explain why a greater injury in the lower rectum would lead an unsatisfactory of curative effect, even if coagulation factors were supplemented to a normal level.…”

Section: Discussionmentioning

confidence: 99%

Recurrent bleeding after rubber band ligation diagnosed as mild hemophilia B: a case report and literature review

Jiang

Ding

et al. 2022

BMC Surg

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Background Hemophilia is a recessive hemorrhagic disease relevant to X chromosome. In mild hemophilia cases, spontaneous bleeding is rare and the blood clotting function is normal, but severe bleeding may occur after trauma or surgery. Therefore, missed diagnosis of hemophilia before operation may contribute to bleeding after hemorrhoid operation. Case presentation A 21-year-old male was hospitalized in the anorectal department because of repeated bleeding after hemorrhoid surgery. Despite several suture hemostasis procedures, the patient still suffered from recurrent bleeding. He had no family history of hemophilia or bleeding tendency, and had not been diagnosed with hemophilia before this admission. The diagnosis of mild hemophilia B was made after further examination of coagulation indexes. By using frozen plasma and coagulation factor complex to supplement coagulation factors, the patient’s bleeding was stopped and he was discharged after 23 days in hospital. During the follow-up, lower-than-normal coagulation factors were still found in him, but no bleeding occurred again. Conclusions The undiagnosed patient with mild hemophilia B has an increased risk of bleeding after hemorrhoid surgery because of the consumption of coagulation factors. This case report aims to address the importance of hemophilia screening before operation and reduce the risk of postoperative bleeding. For patients with recurrent bleeding after hemorrhoid surgery, hemophilia should be further excluded. Wound bleeding may recur in hemophilia patients after suture hemostasis. Therefore, prompt supplementation of coagulation factors is needed to help stop bleeding once the diagnosis of hemophilia is made.

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“…The use of antifibrinolyt ics intraoperatively for major ortho pe dic sur ger ies has been shown to decreased perioperative and post op er a tive bleed ing in hemo philia. 12,13 Overall, the use of TXA dur ing major sur ger ies has not shown an increased risk for throm bo em bo lism. 14 Neuraxial anal ge sia Before pro ceed ing with neuraxial anal ge sia, the fac tor level should be increased to at least 50% (Table 4).…”

Section: Antifibrinolyticsmentioning

confidence: 98%

“…The use of phar ma co logic pro phy lac tic anticoagulation has not been shown to increase post op er a tive bleed ing in patients with hemo philia. 13…”

Section: Thromboembolic Pro Phy Laxismentioning

confidence: 99%

Perioperative hemostasis for patients with hemophilia

Poston

Kruse‐Jarres

2022

Hematology

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LEARNING OBJEC TIVES• Identify key com po nents to con sider in the pre op er a tive plan ning for patients with hemo philia • Understand the goals of fac tor replace ment dur ing the perioperative period Assuring the nec es sary resources are in place Access to advanced coag u la tion test ing, clot ting fac tor con cen trates (CFCs), and hema tol ogy con sul ta tion must be avail able dur ing the perioperative period and con sid ered when patients decide where to receive sur gery. 4 Ide ally, patients will be connected to their local HTC and have access to HTC sup port through out the perioperative course. Considering the postdischarge envi ron mentAdditionally, reviewing the patient ' s abil ity to self infuse CFCs is key to plan ning post op er a tive CFC replace ment if needed, depending on the sever ity of hemo philia and sur gi cal bleed ing risk. Patients with hemo philia who do not know how to self infuse or have not recently self infused CFCs are bet ter served by receiv ing short term intra ve nous access prior to sur gery and may require appoint ments for CFC infu sions post op er a tively.

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Postoperative bleeding complications in patients with hemophilia undergoing major orthopedic surgery: A prospective multicenter observational study

Cited by 23 publications

References 37 publications

Complications and Implant Survival of Total Knee Arthroplasty in People with Hemophilia

Complications and Implant Survival of Total Knee Arthroplasty in People with Hemophilia

Recurrent bleeding after rubber band ligation diagnosed as mild hemophilia B: a case report and literature review

Perioperative hemostasis for patients with hemophilia

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